Platform switch

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Platform switch to be or not to be?

• Andrija Petar Bošnjak
• School of Dental Medicine, Zagreb, Croatia
• Andrej Meniga
• Private practice, Zagreb, Croatia
• Ann Wennerberg, Victoria Fröjd
• School of Dentistry, Göteborg, Sweden

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Background

• Bone resorption to the first thread during
  initial loading
• Biologic width around implants (Berglundh
  Lindhe 1996)
• No resorption when an abutment with a narrower
  diamater is connected to the implant (Gardner
  2005) so called platform-switching

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Objective

• Evaluation of the difference in histological
  findings between a platform-switching
  implant-to-abutment interface using a tight seal
  and a flat-to-flat interface
• Differences in ISQ values during 3 months for
  implants with transmucosal healing (one-stage
  procedure)

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Material and methods

• 26 consecutive patients treated with 43 Ospol
  study implants
• 4.0 diameter, implant length of 10, 12 and 15 mm
  supporting single crowns or fixed partial
  dentures
• 36 implants (83.7) single tooth replacements
  in lateral parts of mandible (58.8) and maxilla
  (41.2)

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Material and methods

• Paired implants
• One with a healing abutment creating
  flat-to-flat interface
• One with a standard abutment creating platform
  switch interface

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Material and methods

• 22 mm biopsy of soft tissue was acquired 3
  months after implant placement for histological
  evaluation (at the time of crown/fixed partial
  denture fixation)
• Immersed in sodium-cacodylate solution and
  subsequently analyzed

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Material and methods

• Radiographic assessment of marginal bone level
• At the time of implant placement
• At 3 months recall (time of crown fixation)
• All patients were recalled monthly during
  osseointegration process
• ISQ measurements at the time of surgery and 3
  months postoperatively

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Results

• Cross-sections of fixated samples
• Inflammatory cell inflitrate
• Thickness of the epithelium
• Thickness of the connective tissue

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Platform switch

• No substantial number of inflammatory cells
• Epithelial thickness
• Well-defined rete pegs
• Connective tissue layer

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Flat-to-flat

• No substantial inflammatory cell infiltrate
• Epithelial thickness
• Connective tissue layer

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ISQ measurements
Platform-switch ( SD) Flat-to-flat ( SD) p
At implant placement 72.5 6.3 71.8 5.9 NS
At 1 month 77.3 4.2 77.1 3.8 NS
At 3 months 81.8 5.5 80 4.7 NS
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Conclusion

• Histologic analysis is in the early stage, but
  there is no significant inflammatory cell
  infiltrate
• Platform-switch seems to be as reliable for
  one-stage procedures as flat-to-flat interface
• ISQ measurements confirm that the stability was
  maintained during initial three months of healing

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Further developments
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Further developments
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Further developments
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Acknowledgments

• Ospol, Malmö, Sweden
• Göran Urde Hans Berglund _at_ Ospol, Malmö, Sweden
• Petra Hammarström Johansson _at_ Dept
  Biomaterials/Handicap Research, Göteborg, Sweden
• Martina Vlah, Gordana Sporis Lana Vodopija _at_
  Meniga Bosnjak LLC, Zagreb, Croatia
• Kresimir Sankovic, School of Pharmacy, Zagreb,
  Croatia
• Drazen Jovicevic, Dental Laboratory, Zagreb,
  Croatia