Indian Journal of Dental Research

LETTER TO EDITOR
Year
: 2015  |  Volume : 26  |  Issue : 6  |  Page : 652--653

Platform switching: Hype or reality?


Shefali Singla1, Manu Rathee2,  
1 Department of Prosthodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
2 Department of Prosthodontics, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India

Correspondence Address:
Shefali Singla
Department of Prosthodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh
India




How to cite this article:
Singla S, Rathee M. Platform switching: Hype or reality?.Indian J Dent Res 2015;26:652-653


How to cite this URL:
Singla S, Rathee M. Platform switching: Hype or reality?. Indian J Dent Res [serial online] 2015 [cited 2020 Apr 10 ];26:652-653
Available from: http://www.ijdr.in/text.asp?2015/26/6/652/176938


Full Text

Sir,

The maintenance of peri-implant bone is an important factor in the prognosis of implant supported prosthetic rehabilitation. Likely causes of crestal bone loss (CBL) are surgical trauma, occlusal overload, peri-implant inflammatory infiltrates, micro-gap and micro-movement at implant abutment junction (IAJ) and the establishment of so-called biological width around implants. Up to 1.5 mm CBL in the 1 st year and subsequently 0.2 mm annually is an accepted hazard (Albrektsson 1986). Recently, several techniques have been developed to minimize CBL, such as non-submerged technique, using rough surface implant neck with microthreads, scalloped implants, and platform switching (PS).

PS (Lazzara 2006) refers to use of smaller diameter abutments on wider diameter implants. This design displaces IAJ horizontally inward, creating a step between the abutment and implant and allows the biologic width to be established horizontally. PS increases the distance between inflammatory response at the micro-gap and the crestal bone, thereby, minimizing the effect of inflammation on crestal bone remodeling. Furthermore, stress concentration zone is shifted away from the crestal bone-implant interface.

Recent systematic reviews on merits of PS versus platform matched (PM)implants by Strietzel et al. [1] and Atieh et al., [2] report that only a few studies in literature could be included in the review owing to great heterogeneity in these studies in their own case-control groups, in terms of implant neck geometry (smooth neck vs. roughneck with microthreads), implant-abutment connection, implant systems used (same/different manufacturers and designs), surgical protocols (submerged/non-submerged), placement level in relation to crestal bone, loading protocols (immediate/delayed), and degree of platform mismatch used. A study by Cannullo et al. (2010), favored PS, but they had used implants with microthreads in neck design and did not have any control group. Studies have shown that rough surface with microthreads at implant neck help to preserve peri-implant crestal bone and might mask the actual effect of PS on crestal bone preservation. Another confounding factor is the depth of implant placement. Histomorphometric analysis by Broggini (2006) showed that subcrestal IAJ promoted a greater density of neutrophils leading to inflammation and greater bone loss. Fickl et al. (2010) observed significantly less bone loss in PS group, but their results should be interpreted taking into account that they placed PS implants crestally and PM implants subcrestally. Crespi et al. (2009) used different implant systems for PS (Ankylose-Morse taper connection) and PM group (Sweden and Martina-External hex with smooth collar), and their results showed no significant difference in CBL in the two groups. Vela Nebot et al. (2006) concluded that in PS implants, invasion of biologic width and hence bone loss is reduced. However, their follow-up period was 6 months, and they used both, one step and two step surgical protocol in their study. Successful results in favor of PS in above-mentioned studies may be partially attributed to these confounding factors. Moreover, only two studies have been conducted with PS and PM implants placed in the same patient. One by Enkling et al. [3] could not confirm the hypothesis of reduction in CBL with PS implants whereas Trammell et al. [4] could demonstrate a difference of only 0.2 mm in CBL in PS versus PM implants placed in the same patient. The inherent measurement variability in periapical radiographs has to be considered while interpreting such data.

Though PS appears to be a promising tool in preserving peri-implant bone, further research using same design features and treatment protocol in the same patient is needed to define its need and substantiate its application in contemporary implantology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Strietzel FP, Neumann K, Hertel M. Impact of platform switching on marginal peri-implant bone-level changes. A systematic review and meta-analysis. Clin Oral Implants Res 2015;26:342-58.
2Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone preservation around dental implants: A systematic review and meta-analysis. J Periodontol 2010;81:1350-66.
3Enkling N, Jöhren P, Katsoulis J, Bayer S, Jervøe-Storm PM, Mericske-Stern R, et al. Influence of platform switching on bone-level alterations: A three-year randomized clinical trial. J Dent Res 2013;92 12 Suppl:139S-45S.
4Trammell K, Geurs NC, O′Neal SJ, Liu PR, Haigh SJ, McNeal S, et al. A prospective, randomized, controlled comparison of platform-switched and matched-abutment implants in short-span partial denture situations. Int J Periodontics Restorative Dent 2009;29:599-605.