platform switching in implant

1. 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

2. 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

4. 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)

6. 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%)

7. Material and methods
Paired implants
 One with a healing
abutment – creating
flat-to-flat interface
 One with a standard
abutment – creating
platform switch interface

8. Material and methods
2×2 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

10. 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

12. Results
Cross-sections of fixated samples
Inflammatory cell inflitrate
Thickness of the epithelium
Thickness of the connective tissue

13. Platform switch
No substantial number of inflammatory
cells
Epithelial thickness
Well-defined “rete pegs”
Connective tissue layer

14. Flat-to-flat
No substantial inflammatory cell
infiltrate
Epithelial thickness
Connective tissue layer

16. 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

17. 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

19. Further developments

20. Further developments

21. Further developments

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