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Ask UsPlatform Switching: Which Implants are Designed for This?
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Dr. V., from Spain, asks:
I am an oral surgeon practicing in Spain. Some of my referring dentists have asked me about platform switching. I am more familiar with the surgical than restorative side of treatment. Do all implant brands have the capability of platform switching or are only some implant brands designed for this? Anything I should be concerned about? Does platform switching increase the chance of peri-implantitis? Thanks.
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34 Responses to “ Platform Switching: Which Implants are Designed for This? ”
Hi…
If You use for exemple implant 4mm diameter and abutment 3,5 diameter-You have -Platform switching-pseudo platform switching.
Biomet 3i implants-Prevail- are designed for this new concept in implant dentistry.
http://www.ncbi.nlm.nih.gov/pubmed/16515092
Kris
The Nobel Active implant has a built in platform switch into the design and the abutment is platform switched as well. Great implant.
Platform switching moves the inflamatory zone of the connection between the abutment and implant interface inward, reducing the distance allows for the hard tissue to maintain a higher level of interface with the implant surface. I’ve seen a new implant by Nobel Biocare that solves the micro gap issue as well as the platform switching, NobelActive.
Ankylos Friadent Dentsply ( Real platform switch )
and Straumann Bone Level ( Just really new)
Best regards from Germany
Stefan
3i, Astra, the Straumann bone level thingy, Nobel Active are all designed to platfrom switch.
Platform switching is flavour of the month lately but is just an attempt to overcome a design fault that almost all manufacturers have - namely an “open” interface junction. There would not be an inflammatory zone at the interface if it was sealed. There would not be the bacterial leakage if the abutment was cemented into the implant. Sounds radical but it works with crown and bridgework.
Have been using a British system for 21 years in which the abutment cements into the implant and it works like a charm. Another useful function of thei method is that you do not get screw-loosening under cemented crowns. If anything goes it is just the glass ionomer cement so all you have to do is retract the gingiva and recement (and check the occlusal problem that caused the debonding).
any comments on the bicon implants.. a good seal is obtained to keep the inflammatory zone away..
Dr. V In what situations does your restorative dentists request this medialized abutment connection? When do you feel that this mode of connection is MOSTessential?
Another benefit of platform switching, from a physics perspective, is lateral stresses are not concentrated at the coronal aspect. I believe Astra solves this problem best with it’s parallel walled internal connection. I believe Dr. Colwan (sp?) from OK is working on an internal connection collete system and a cementable platform, whereby the implant has ferrule and the abutment (parallel) acts like a post. Thus, all forces are transmitted evenly down the implant.
Can someone clarify my comments?
On mechanical aspect of platform switching,we have done a stress analysis and found there is a perceivable/significant difference between switched and non switched forces transmitted to the bone interface and with in the implant favouring the switched situation.Most interestingly the angled switched abutment with st.forces is more favourable than the switched st.abutment giving a clinical clue that when ever we use angled abutments, it is preferable to switch platform
Hello,
beside some already mentioned systems the 2007 launched German implant “IQ:NECT” (by Heraeus Kulzer) has a real integrated platform- switching built-in as the internal connection of implant/abutment is independent of the diameter.
This screwless system shows a monoblock-analogue connection. The massive abutments can be individualized by the lab to fullfill even difficult esthetic requirements (e.g. high angulations) without the known limitations of the screw channel.
The goal of platform switching is to prevent the (previously) normal bone loss down to the first thread that occurs around most implants, thus enhancing soft tissue aesthetics and stability. One of the main causes of this bone-loss is the bacteria that lives in the micro-gap between the implant and the abutment and the resultant inflammatory zone (as previously mentioned). Platform switching by using smaller diameter abutments moves the micro-gap and inflammatory zone away from the bone, thus minimizing bone loss. Another method of platform switching and eliminating bone loss is the type of connection. Parallel or tapering implant-abutment interfaces (Ankylos, Bicon, Astra were the first to do so in the 1980’s, and since the patent on that type of connection expired, Straumann and Nobel Biocare also have followed suit with tapering interfaces) automatically platform switch providing the the advantageous decreased transmission of forces at the implant bone interface. The other advantage (proven in the older systems, I’ve not seen independent research on the new ones) is that the micro-gap is virtually eliminated (it is smaller than the bugs that want to live there). This leads to almost no bone loss around the implants resulting in better soft tissue aesthetics and decreased likelihood of peri-implantitis. Is is a huge paradigm shift (it was for me), but the results are mind-blowing.
Flavor of the month. That sums up the concept. Where are controlled clinical studies that show this to be a valid concept? If my “gap” is .2 mm further in toward the center of the implant how does that make it better? Since when did cement stop bacteria. That is like saying my crown margins are wide open so I fill them with cement and now they are ok. I have had patients that have had wider diameter implants, especially in the molar region, that were platform switched and with the reduced support the crowns kept coming loose. The actual cause was a poor fitting crown, but the point is that this is a theory, not a fact.
There are those that say that the new microthread stops the bone loss. Lots of Theories, but no hard science. Probably because it is next to impossible to create studies that work and get them funded.
Another benefit of platform switching, from a physics perspective, is lateral stresses are not concentrated at the coronal aspect. I believe Astra solves this problem best with it’s parallel walled internal connection. I believe Dr. Colwan (sp?) from OK is working on an internal connection collete system and a cementable platform, whereby the implant has ferrule and the abutment (parallel) acts like a post. Thus, all forces are transmitted evenly down the implant.
Can someone clarify my comments?
To Michael P:
Yes, Dr. Callan out of Arkansas has designed a system, PerioSeal, which has closed the microgap up inside the prosthetic by manufacturing a ridge on the implant for the crown to sit on…thus a ferrule attachment (patented in US and Europe). The other aspect of the system that I love is the internal collet locking mechanism…it is friction based and when combined with the ferrule it has given my patients and me peace of mind. This greater surface area of contact and the better distribution of occlusal force create a strong connection without a micro-gap that harbors the periodontal pathologic bacteria. With the ferrule attachment, the dental cement, and the internal collet lock engaging the implant, the connection of the PerioSeal Implant is significantly stronger than any standard external or internal hex connection.
I am not sure if they have any DRs in Europe, however you won’t be dissatisfied, and the beautiful thing is I save thousands a year by using PerioSeal and get great results….not to say the other systems aren’t great because I really like Straumann too, however I don’t have to buy a $350 implant and an expensive abutment to get the results the patient wants. Do your research!
I agree with most of the posts here…I have friends that are trying the platform switching and not getting the desired results….good concept on paper, however show me long term studies and then I might start to believe….MARKETING wins with these companies, because as physicans we have become very lazy in reading the REAL research…
Using logical thinking, what is the advantage of the platform switch? If the problem is the level of the biologic width, one gets all of .5mm. That is all the microgap is moved. The change in stress at the crest seems to have some science. However if the previous two piece implant with a connection is a problem, we should have millions of failures. The one piece implant like the Straumann, already has the micrograp away from the bone crest and the polished collar gives you 1.8mm for the soft tissue to attach. My take on this concept and the flavor of the day is that we are looking for a solution to compensate for a design problem when a better design has already solved the problem.
Dr. Claassen sums it up nicely. Platform switching combined with a reduced or eliminated microgap does work incredibly well when it comes to improved tissue health and contour and reduced bone remodeling around the neck of the implant. All major systems have these implants now(Astra Tech, 3i, Straumann, and Nobel). Astra Tech has over 14 years experience here and their system seems to be one of the best.
To Dr. Brooksby, I say try it and you’ll see the results for yourself. If you’re interested in minimal bone loss, less probing depth, better tissue contour and healthier peri-implant tissue, you’ll like what platform switching and a tighted abutment/implant seal are capable of providing.
Scott is right there! How many angles dance on the head of a pin. How many factors determine where the bone ends up around your implant? How do we best support the biological demension? There are so many co-related factors that at one time or another we were all exposed to that relate to maintaining bone height. What about the skill of the surgeon as a very big factor? Design of the prosthetics? Macro and micro geometric design? Nanotechnology? Patient selection? We enjoy great success already, over 96% where are we taking this to? I am all for striving for perfection and settling for excellence. When you add up all the varriables that affect bone height the medialized abutment has an advantage as described above, but what for; that additional .5mm? Where do you need this? To avoid the little black hole? I “think” that it helps and especially in the area of tooth 8@9 being replaced by 2 implants side by side, and in the esthetic zone you may be able to be a little closer together, again to support the soft tissue. Think about just how vital the concept actually relates to our success along with the other factors.
I agree there is not a perfect solution in the market, however I do agree with “rbk”….the problem has been solved for the most part, however there are some other factors that assist in this as well. The PROBLEM again is when a major competitor can’t compete by designing an implant to mimic the solution of another competitor…the result is they change the subject and create another topic to add to the confusion and take the physicians focus off the other topic….then to add more confusion for other competitors to compete they have to follow suit….it is a whirlwind of GREAT marketing!!!
Study the body and the way it heals….this will tell you all you need to know on what you need to use in your practice….
Again I will say there is no need to spend $350 on an implant to get a great result….I am certainly not using one, and I am not having these problems!!!
AMEN
I don’t think that the seal is perfect for any connection in the two stage implant. Since the biological width is blind for vertical or horizontal dimensions, you get a 1mm extra for the biological width by switching the platform. That is the only trick there is. You can sometimes see teh same trick with normal teeth with underrestored margins that are going unexpected well! By giving more dimension to the soft tissue in this way and the interaction between soft and hardtissue on cellular level you get a strong tissue and the better stress distibution will give less resorption from the bone as well. Otherwise with no microcap all the one piece implats should do far more better then two stage implants
I agree that with an interferance fit and virtually no micromovement between the abutment and the platform you will reduce or eliminate hydrolic pumping of endotoxins into the bone otherwise making unfavorable circumstances for the bone. Furthermore, using the medialized abutment moves the microgap away from he bone by some deminsion which again removes unfortunate circumstances for the bone. However, to say that a one piece design implant/abutment will do far better than the two stage design is not logical.Don’t we all see 98% success after years of service. Back in the 60’s Herb Shielder fromBoston said they were getting nearly 100% success with silver points for obturation. A few years later he stated that they were now using gutta percha cones and even doing better! How good is good enough? There is a time and a place for the switch. Otherwise the value is limited. Its a good thing to be used considering patient selection.
If thinking about an abutment narrower than the implant diameter then you should add the Zimmer Screw vent 4.1mm to the list of implant with the switching platform principle because it use a 3.5 prosthetic part.
Bone loss is a bio-mechanical and stress management issue not bacterial…
it is funny how 3i calls it platform switching and nobel calls it platform shifting…
Also with MIS Seven 4.2 and 5mm diameter implants you have plataform switching. By the way this implant has a very good design, incredible initial stability.
somebody have experience about gapseal? to reduce inflamation arround abutment and top of implant
This is a great topic causing significant number of discussions for over a decade now. Platform switching was first designed (by accident, as many other great things in science and practice) by Ankylos (Friadent Dentsply) and is inherent to conical shape of implant-abutment connection. Most of the stuff is already said in this discussion, so I can only add that one more implant system uses this type of connection (true conical) and implant switching, and that is Ospol, designed by a fabulous little NB renegade team in Sweden.
To Peter Fairbairn: You seem quiet definite in your opinion of the cause of peri-implant bone loss. I’m not convinced you’re entirely correct and I’m not sure anyone has all the answers at this stage. It does make for stimulating discussion!
SteveC: Prosthesis overload>Implant body micro-fracture>Nidus for bacterial invasion>hydrolic pumping of endotoxins>bone loss. Overload and the bacteria are secondary in the etiology. Perhaps, most probable cause for peri-implant disease.
Platform switching is a concept that was accidently discovered by some guys doing research on healing (cant remember the study)
They had inadvertantly left the impression copings on the implants instead of the abutments which are narrower than the implant body..and found some positive results ..so the story goes like all good discoveries !
It addresses 2 issues
1)Medial movement of microgap
Micro gap was historically blamed for bone loss to first thread phenomenon
However ITI had the first one piece implant and claimed no bone loss to first thread ..they seem to have had a point ..however I still saw loss to first thread in many cases?
It may have been due to other factors however
Either way the microgap story in todays hi tech machining is no longer applicable as the accuracy of parts today pretty much eliminated this gap
Its not as if we dont have success with implants with a potential microgap!
2) The second issue is the fact that if the Abutment gets narrow above the bone ..we have more soft tissue
this effectivly allows a good seal around the transmucosal component of the implant
this kind of makes sense as you expose the inside of the body to the outside you want a good seal and a design that encourages more connective tissue is probably a good thing
Bicon have had this concept from the beginning and seem to work well (dont like anything else about their implant though!)
Now it is very fashionable, as it does seem to have a thread of logic
I have no doubt however that this is great marketing material so naturally the companies are seizing on it
For the record IMTEC/Endure also have a platform switch with their new 5mm wide body implant as the same prosthetic components are being used for the narrower implants
There seems to be a huge disconnect as to what platform is and is not. This term is used collectively to describe both abutment connections and the tissue response. First, let’s discuss what platform “switching” really is. When the first Frialit implant was released, it had an internal hex that was interchangeable with all of the diameters. When it became apparant that “accidental” use of a smaller abutment than the desired diameter made for the implant actually preserved crestal bone, we began using this paradigm in select cases. The CHOICE of abutments of different diameters allowed us to switch connections to preserve thin biotype cases in the esthetic zone. The other implants that are characterized as such (i.e. Astra, Bicon, Ankylos) are platform “SHIFTED”. There is only one abutment connection at the submergence level and therefore no choice to switch the abutment diameter. The soft tissue response is identical when the implant submergence profile is medialized. I hope that the implant community will begin adopting this new term to more accurately reflect the differences in implant design. RJM
I do agree with dr robert miller where bicon ,astra & ankylos have a shifted platform that really works . I think the reason behind the success is bifold : design of connection + the friction fit joint . doing the switching platform connection with a slip fit joint (where there is space between components leading to micromotion & bacterial pmping ) will not prevent crestal bone loss and will be of no benefit .
The Neoss system has built in platform switching as they have only one platform. All fixtures wider than the 4.0 (4.5,5.0,5.5) by definition platform shift. I pretty much like all the features of this fixture.
Perhaps the first platform switching implant was the Core-Vent in 1982 because it had a narrow post cemented into a wider implant. The only thing that has changed since then is that 3i, using a wider implant to reduce screw loosening with external hex implants, but not having all the abutments of a matching diameter, started recommending their standard abutment and came up with a story (platform shifting or switching) to claim that this misfit in diameters actually served a purpose of moving the micro-gap away from the bone. The junction between the abutment and the implant, called Micro-gap, by some, is not a problem if the joints stay together. With external hex connections, this was not as predictable as with internal connections and a loose connection can cause bone loss, but really bone loss is more related to how thick the labial plate is at time of implant placement (Proven by VA Study, JOMS Special Issue).
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