• Users Online: 270
  • Print this page
  • Email this page


 
 
Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 9-12

Platform switching technique: An updated review


Department of Periodontics and Oral Implantology, Santosh Dental College and Hospital, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India

Date of Submission12-Apr-2022
Date of Acceptance25-Apr-2022
Date of Web Publication21-Jul-2022

Correspondence Address:
V Pradeepkumar
Department of Periodontics and Oral Implantology, Santosh Dental College and Hospital, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sujhs.sujhs_13_22

Rights and Permissions
  Abstract 


Modern dentistry aims to facilitate the patient to achieve excellent oral health. An ideal implant prosthesis can not only provide normal muscle activity, thereby improving the functions of mastication, but also improve esthetics profoundly. Among the factors involved to attain good esthetic result with implants, the correct positioning of the implant is one of the most important factors, along with preserving the integrity of gingival margins and interdental papillae. Preserving crestal bone is paramount, while planning for implant placement as it accumulates bacteria and leads to secondary peri-implantitis. Hence, the objective of this review article is to highlight the advantages of platform technique as compared to conventional treatment approach.

Keywords: Crestal bone level, implant–abutment interface, platform switching


How to cite this article:
Pradeepkumar V, Nautiyal A, Bali S, Aggarwal P. Platform switching technique: An updated review. Santosh Univ J Health Sci 2022;8:9-12

How to cite this URL:
Pradeepkumar V, Nautiyal A, Bali S, Aggarwal P. Platform switching technique: An updated review. Santosh Univ J Health Sci [serial online] 2022 [cited 2022 Dec 8];8:9-12. Available from: http://www.sujhs.org/text.asp?2022/8/1/9/351561




  Introduction Top


Modern dentistry aims to facilitate the patient to achieve excellent oral health. The edentulous patient who has partial or complete missing dentition has disadvantages in mastication, esthetics, and phonation with the use of removable prosthesis. The masticatory efficiency of a removable denture user is reduced to about one-sixth when compared to that of natural dentition.[1] An ideal implant prosthesis not only provides normal muscle activity but also improves the functions of mastication close to normal limits along with stimulating the bone and maintaining its dimension likely to healthy natural teeth.[2] Among the factors involved to attain good esthetic result with implants, the correct positioning of the implant is one of the most important factors, along with establishing the optimum volume of hard and soft tissues.[3] The peri-implant bone level is the major criteria to estimate the success of dental implants. It is an important prerequisite for preserving the integrity of gingival margins and interdental papillae.[4] Preserving crestal bone is paramount when planning for implant placement as it can lead to increased bacterial colonization resulting in secondary peri-implantitis and bone loss hence resulting in occlusal overload resulting in implant failure. Apart from this, resorption of marginal bone will affect the gingival contours and may result in loss of interproximal papilla.[1] Hence, the objective of this review article is to highlight the advantages of platform technique as compared to conventional treatment approach.


  History Top


In the late 1980s, platform switching (PLS) was a serendipitous discovery; its benefits have in today's times become the prime focus of implant research with a significant consideration for preventing initial peri-implant bone loss. It so happened that due to the increased demands of wide diameter implants in the late 1980s, a scenario was created in which implants with ill-match standard diameter abutments were used due to lack of commercial availability of equal wide-diameter implants. This led to a form of treatment unintentionally labeled “change of platform,” which has come to be known as “PLS.”

As luck would have it, these implants exhibited an impressive property of inhibiting initial crestal bone loss. Several case reports implied improved soft and hard tissue responses to these platform-switched implants, hence encouraging many implant companies to integrate PLS into their systems for narrower body implants.[1]


  The Concept Top


PLS technique comprises placing narrower diameter restorative abutment on implants of wider diameter, rather than matching abutments of similar diameters[5] [Figure 1]. These intended to increase the bone to implant contact in areas of limited bone height. At that time, the same dimension of prosthetic components was not easily available; hence, clinicians restored them with standard 4.1 mm diameter components, which provides a 0.45–0.95 mm circumferential horizontal difference in dimension between the implant seating surface and the attached component.[6]
Figure 1: Interaction between abutment and implant in regular implant and PLSI. PLSI = Platform-switching implants, IAJ = Implant–abutment junction

Click here to view


The interrelation between implant surface and its restorative abutment is termed the implant–abutment interface or “microgap.” In most cases, this creates micromovements during clinical function permitting microleakage of fluids [Figure 2]. This microleakage is permanently present as an area of abutment inflammatory cell infiltrate. This continuous state of inflammation encourages both osteoclast formation and activation contributing further to bone loss, to overcome this instead of using platform-matched implants, platform-switching implants (PLSI) protects microleakage of fluids and effective against infiltration of abutment inflammatory cells.[6]
Figure 2: Healthy and unhealthy soft and hard tissues on peri-implant area

Click here to view


PLS helps in biologic width extension and decrease in alveolar bone loss, hence influencing microgap on the crestal bone and reduces the stress levels around the peri-implant bone alongside enhancing the force in and around the screw.[7]

Indications

  • Anatomic structures limiting the residual bone height
  • Implant placement in narrow edentulous ridge
  • Situations with limited prosthetic space desiring larger diameter implants
  • To achieve good esthetic results in anterior maxilla
  • If shorter implants are used in atrophic areas.[8] Contraindication: If normal-sized abutments are to be used, implants of larger size need to be placed. This might not be possible clinically always
  • If normal implants are to be used, smaller diameter abutments may compromise the emergence profile in esthetic areas
  • Close to 3 mm of soft tissue is needed to place platform-switched implants to avoid resorption or else bone resorption is likely to occur
  • Undersizing of the components must be carried out during all phases of the implant treatment for the placement of PLS.[4]


Advantages

  • Inflammatory cell infiltration takes place in implant–abutment junction (IAJ), forms collar-like fashion within the angle formed at the interface between implant seat and abutment, that prevents the apical migration of inflammatory cells, thus reduces the biological influence at the marginal bone
  • Horizontal dimensions near interface and abutment allow additional connective tissue attachment, thus preventing remodeling of the crestal bone
  • The influence of micro gap on bone resorption may be avoided by the soft tissue junction inward from the marginal bone.
  • Good bone support is provided in the area where short implants are necessary when anatomical structures situated underneath, e.g., maxillary sinus and inferior alveolar bone.[2],[8]



  Discussion Top


Adell et al. in 1981 conducted a 15-year retrospective study to quantifying early crestal bone loss. They reported 1.2-mm marginal bone loss from the first thread during healing and in the 1st year after loading with an average 0.1-mm bone loss annually.[9] Vertical bone loss (<0.2 mm) annually following the 1st year of implant function is the criteria for implant success as given by Smith and Zarb in 1989. A postrestorative remodeled crestal bone generally up to the level of the first thread on most standard diameter implants. The first thread changes the shear force of the crest module to a component of compressive force to which the bone is most resistant.[10] Hermann et al. in 2007 reviewed biologic width, PLS, and implant design in the cervical region, nanoroughness, fine threads, insertion depths, abutment design, and elimination of microlesions in the peri implant soft tissue as factors that used for preservation of crestal bone levels. According to them, these factors along with several others determine the esthetic outcomes of implant restorations.[11]

In 1997, Abrahamsson et al. in 1998 revealed that multiple screwing and unscrewing movements of the healing screw make the junctional epithelium moves toward apically around the implant collar. This reveals that this epithelial migration results, in turn, in an apical relocation of the bone level, so that a biologic width reconcilable with the health of the peri-implant tissues is restored. Biologic width completely forms within the first 6 weeks after the IAJ got introduced to the oral cavity. It is the barrier against bacterial invasion and food ingress at the implant–tissue interface.[12] Gardner in 2005 demonstrated the literature dealing with the changes occurring during implant placement using PLSI. He suggested the main advantage being an excellent way to limit peri-implant circumferential bone loss and concluded that this technique needs further investigation. However, he quoted some potential disadvantages of this procedure such as the need for components with coinciding screw access holes and adequate space to maintain proper emergence profile.[13] In a 3D finite element analysis, Hsu et al. in 2009 stated that PLS results to a small reduction of <10% in crestal bone strain. However, it does not significantly influence crestal bone strain or micromovement.[14] Prosper et al. in 2009 in a randomized prospective study compared platform-switched implants and implants with an enlarged platform to cylindrical implants inserted with conventional surgical protocols having abutments of matching diameter. A significantly reduced postrestorative crestal bone loss was seen, when implants were placed in both two-stage and one-stage techniques.[15] Cappiello et al. in 2008 confirmed the important role of the microgap between the implant and abutment in the remodeling of the peri-implant crestal bone. Platform switching seemed to reduce peri-implant crestal bone resorption and increase the long-term predictability of implant therapy.[16] Canullo et al. observed that implants with platform-switching technique experienced significantly less marginal bone loss when compared to their conventional counterparts.[17]


  Conclusion Top


Many factors contribute to marginal bone loss around implants and its solution cannot be assigned to any single parameter.[13] Crestal bone loss has been documented as one of the important factors that affect the long-term prognosis of a dental implant.[6] Glimpsing through the available literature and reviewing it thoroughly, within the limitations of this article, we conclude that PLS significantly contributes not only to maintaining the width and height of crestal bone but also to limiting the bone loss circumferentially. This is to conclude that the implant design modifications in PLS technique offer many advantages, which include situations wherein a larger implant is desirable in a limited prosthetic space and especially in the anterior esthetic zones where crestal bone preservation can lead to enhanced esthetics.[1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Misch CE. Rationale for dental implants. In: Contemporary Implant Dentistry. Vol. 3. Elesevier Publications, 11830 Westline Industrial Drive St. Louis, Missouri; 2008. p. 21.  Back to cited text no. 1
    
2.
Vijayalakshmi R, Ramakrishnan T. Platform switch dental implants-search for evidence: An overview. SRM J Res Dent Sci 2016;7:101-5.  Back to cited text no. 2
  [Full text]  
3.
López-Marí L, Calvo-Guirado JL, Martín-Castellote B, Gomez-Moreno G, López-Marí M. Implant platform switching concept: An updated review. Med Oral Patol Oral Cir Bucal 2009;14:e450-4.  Back to cited text no. 3
    
4.
Desai MH, Patil VA. Platform switching: A panacea for bone loss?? J Indian Soc Periodontol 2013;17:681-3.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Baumgarten H, Cocchetto R, Testori T, Meltzer A, Porter S. A new implant design for crestal bone preservation: Initial observations and case report. Pract Proced Aesthet Dent 2005;17:735-40.  Back to cited text no. 5
    
6.
Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent 2006;26:9-17.  Back to cited text no. 6
    
7.
Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, et al. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2003;74:1785-8.  Back to cited text no. 7
    
8.
Kalavathy N, Sridevi J, Gehlot R, Kumar S. “Platform switching”: Serendipity. Indian J Dent Res 2014;25:254-9.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.  Back to cited text no. 9
    
10.
Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous implants. J Prosthet Dent 1989;62:567-72.  Back to cited text no. 10
    
11.
Hermann F, Lerner H, Palti A. Factors influencing the preservation of the periimplant marginal bone. Implant Dent 2007;16:165-75.  Back to cited text no. 11
    
12.
Abrahamsson I, Berglundh T, Lindhe J. Soft tissue response to plaque formation at different implant systems. A comparative study in the dog. Clin Oral Implants Res 1998;9:73-9.  Back to cited text no. 12
    
13.
Gardner DM. Platform switching as a means to achieving implant esthetics. N Y State Dent J 2005;71:34-7.  Back to cited text no. 13
    
14.
Hsu JT, Fuh LJ, Lin DJ, Shen YW, Huang HL. Bone strain and interfacial sliding analyses of platform switching and implant diameter on an immediately loaded implant: Experimental and three-dimensional finite element analyses. J Periodontol 2009;80:1125-32.  Back to cited text no. 14
    
15.
Prosper L, Redaelli S, Pasi M, Zarone F, Radaelli G, Gherlone EF. A randomized prospective multicenter trial evaluating the platform-switching technique for the prevention of postrestorative crestal bone loss. Int J Oral Maxillofac Implants 2009;24:299-308.  Back to cited text no. 15
    
16.
Cappiello M, Luongo R, Di Iorio D, Bugea C, Cocchetto R, Celletti R. Evaluation of peri-implant bone loss around platform-switched implants. Int J Periodontics Restorative Dent 2008;28:347-55.  Back to cited text no. 16
    
17.
Canullo L, Goglia G, Iurlaro G, Iannello G. Short-term bone level observations associated with platform switching in immediately placed and restored single maxillary implants: A preliminary report. Int J Prosthodont 2009;22:277-82.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
History
The Concept
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed973    
    Printed98    
    Emailed0    
    PDF Downloaded99    
    Comments [Add]    

Recommend this journal