Evaluation of evidence in literature of crestal bone loss associated with platform switching of dental implants

Abstract

This study documented Crestal bone loss as one of the important factors that affect the long term prognosis of a dental implant. Currently, concepts to prevent bone loss around dental implants have been reported as the platform switching (PLS). This technique use of prosthetic abutments with reduced width in relation to the implant platform diameter seems to have the greatest potential to limit the crestal resorption.

Methodology

For this study we have utilized the qualitative research approach. Qualitative research is much more subjective than quantitative research and uses very different methods of collecting information, mainly individual, in-depth interviews and focus groups. It was found that 100 articles was a significant sample size for the research.

Results

The result of the litrerature review revealed that bone resorption around the implant neck does not start until the implant has been uncovered and exposed to the oral environment. Exposure invariably leads to bacterial contamination of the gap between the implant and the superstructure.

Discussion

Having reviewed the available literature, we have reached the conclusion that platform switching is capable of reducing or eliminating crestal bone loss. It also contributes to maintaining the width and height of crestal bone and the crestal peak between adjacent implants and it also limits the circumferential bone loss. 

Conclusion

We conclude that the implant design modifications involved in platform switching offer multiple advantages and potential applications, which include situations where a larger implant is desirable but the prosthetic space is limited and in the anterior zone where preservation of the crestal bone can lead to improved aesthetics.



ABSTRACT2

INTRODUCTION5

Background7

Project Aim8

Platform switching concept9

MATERIAL AND METHODS15

Inclusion Criteria15

Exclusion Criteria15

RESULTS16

DISCUSSION19

Clinical studies in human beings19

Factors effecting crestal bone loss around implants22

Micro-gap23

Implant crest module24

Occlusal overload24

Biologic width25

The theory of PLS26

Prevention of bone loss using the PLS technique27

Immediate placement37

Delayed placement in healed sites39

Platform switching effect with respect to inter-implant distance41

Animal studies41

Finite element analysis (FEA)43

CHAPTER 5: CONCLUSION56

Introduction

Currently, dental implants with platform switching are considered to represent the newest concepts in avoiding crestal bone remodeling. It seems that the use of abutments with reduced diameter in relation to the implant platform can greatly reduce crestal bone loss to far less than 1.5 mm, a reference point of successful implant treatment after 1 year of loading, proposed by Albrektsson et al.1 Indeed, a number of retrospective studies reported minimal amounts of bone loss around implants with horizontally nonmatching connection, reaching 0.60 mm after 4 years of loading and 0.70 mm after a follow-up of 7.5 years. and Several controlled clinical trials have shown that implants with platform switching had significantly less bone resorption compared with traditional matching implant-abutment connection. and These statements can also be supported by data from animal and human histological studies indicating the superiority of modified implant-abutment interface to traditional connection. and

From a technical point of view, platform switching is a modification of implant-abutment micro-gap, which is found to be one of the major factors responsible for bone remodeling in the apical direction. However, other factors, such as occlusal loading,14 polished implant neck,15 C.H. Hammerle, ...