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Platform Switching. A Biological Concept

Blog English, Implantology

Introduction

There some questions about what is or what is nor platform switching, and of course, what are the advantages of having a platform-switched concept in the implants used in our daily practice.

Historically we all know what are the success criteria, that we at least, should achieve in any treatment involving implants.

These success criteria were well explained by Albrektsson (Albrektsson et al. 1986), and these criteria currently still prevailing.

In nowadays the patient’s expectations for implant treatments outcomes increased in the last decade, and maybe what it was accepted a few years ago (2mm of marginal bone loss in the first year), maybe are not in accordance with the esthetic expectations of our patients.

But, why that bone loss happens always when an implant is placed?

Ericsson published that this marginal bone loss is related to the concept of “inflammatory cell infiltrate ICT” of the gap between the fixture and the abutment of the implant.

This gap is filled and contaminated by bacterias which leads to a bone resorption.

This article also explains the reason why the biological width is formed around implants, previously described by Berglundh (Berglundh et al. 1991).

Other reasons for bone remodeling around implants are related to other factors, that where described by Abrahamsson and Hermann in other articles that may help us to predict the bone resorption around implants.

These factors are:

– The thickness of the mucosa (Abrahamsson et al. 1996)

– The type of insertion (crestal, supracrestal or infracrestal) (Hermann et al. 2001)

– The design of the implant (Alomrani et al. 2005).

From a clinical point of view, platform switching means…

It is well known the distance that an implant must keep from a teeth and a distance that and implants must have from another implant (Tarnow et al. 2000), although these findings where well discussed in other articles, where we have to keep in mind that maybe old paradigms are nearly to change (Gastaldo et al. 2004).

This distance that we should respect is related to the formation of the biological width around the fixtures.

These concepts are only correct when no platform-switched implants are used. We are going to make a simple explanation of why this happens.

What is platform switching implants?

We could say that platform switching is the implantology Viagra.

Why?

It resulted from a mistake when wide implants became a common treatment option and non-matching abutment where provided to the clinicians.

After these abutments where delivered, during the observationally period, the marginal bone loss was not present in almost every cases (Lazzara & Porter 2006).

Regarding an RCT published by Canullo, the findings are shown in the videos below, where it concludes that the marginal bone loss is reduced when the mismatch is larger (Canullo et al. 2010).

This leads to more research, and Ciurana published that maybe in platform switching implants the distance between implants has not to be 3 mm, but only 2 mm due to the reduction of horizontal bone resorption in the mismatched implants (Rodríguez-Ciurana et al. 2009).

Conclusion

Although the lot of research that has been published in the last years about platform switching implants as a reliable treatment option to maintain the peri-implant bone and soft tissue architecture, there are other factors related with the preservation of marginal bone (Zipprich et al. 2009).

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