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In this first in an ongoing series, Dr. Dennis Tarnow, Professor & Chairman, Dept. of Implant Dentistry New York University College of Dentistry, discusses the popular concept of platform switching as it relates to crestal bone stability, health, survival and color of the soft. In this section, the biology, research and relevance of where the biologic width exists on the implant and how it is affected by clinical circumstances related to macro and micro-geometries of various implant designs is discussed in detail. In addition, how this concept applies to adjacent implants is also outlined.

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Dennis P. Tarnow, DDS Dennis P. Tarnow, DDS
Dennis P. Tarnow is currently Clinical Professor of Periodontology and Director of Implant Education at Columbia School of Dental Medicine. Dr. Tarnow has a certificate...
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Online Videos / Surgery / Implant / Platform Switching: Myth or Reality

Questions & Comments
farshad bajoghli - (11/25/2010 4:58 PM)

great information.i wish we could see the pointer on the slides.because there was no way to see where the pointer was pointing at.but the concept was there.thanks

Devapratim Mohanty - (7/18/2010 8:53 AM)

J Oral Maxillofac Surg. 2007 Jul;65(7 Suppl 1):33-9. Peri-implant bone level around implants with platform-switched abutments: preliminary data from a prospective study. Hürzeler M, Fickl S, Zuhr O, Wachtel HC. Department of Operative Dentistry and Periodontology, Albert Ludwigs University, Freiburg, Germany. CONCLUSION: The concept of platform switching appears to limit crestal resorption and seems to preserve peri-implant bone levels. A certain amount of bone remodeling 1 year after final reconstruction occurs, but significant differences concerning the peri-implant bone height compared with the nonplatform-switched abutments are still evident 1 year after final restoration. The reduction of the abutment of 0.45 mm on each side (5 mm implant/4.1 mm abutment) seems sufficient to avoid peri-implant bone loss. Hope it is allowed to quote studies, Will like to have the valued views of the experts about this offset of 0.45 mm each side as optimum.

Simon Milbauer - (7/18/2010 2:22 AM)

I was reading the commments and start to think whether platform shifting in a form like nobel replace implants for example makes sense. In order to platform switch an adapter has to be attached. this creates an external hex with its weaknesses, and perhaps two microgaps are present once the adaptor is attached. Is it really worth to platform switch implants in this fashion or better to use ines with "built in" platform shift like bicon, ankylos etc? thanks for comments. Simon M.

Devapratim Mohanty - (7/18/2010 12:50 AM)

Thanks a lot Dr Salama for the answer. Wish some one can comment on the most commonly used offset. That will be valuable.

henry salama - (7/16/2010 6:03 AM)

One can apply the platform switch to many implant systems just by mismatching components, i.e. using a narrower diameter abutment than the width of the implant. However, there are a few implants that are specifically designed to gain a greater benefit from the concept and have a rigid connection that I believe synergistically amplifies the effect, i.e. Ankylos, Astra etc. As to what is the most beneficial offset, I am not aware of any studies that give us guidance o that issue.

Devapratim Mohanty - (7/15/2010 7:23 PM)

Sorry for the typing error, I meant implant diameter to abutment diameter.

Devapratim Mohanty - (7/15/2010 12:13 PM)

Which Implant systems are platform switch compartible? Or is just mismatching the implant diameter to the implant diameter will serve the purpose?Last but not the least which is the optimum mismatch ratio for optimum result?

Mitch Silverman - (12/29/2009 6:09 AM)

Thank you Dr. Tarnow. Great lecture! Excellent information.

Gerald Niznick - (12/28/2009 7:52 PM)

[quote=Jay Lutsky]Finally we are back to the key point. Bone loss at the crest is a multifactorial challenge that requires a multi-faceted response. Whether you believe in platform switching or not, there are definitely other factors that are important to consider in your surgical and restorative planning. I'm interested in what other clinicians believe are the other important clinical factors governing bone as well as soft tissue stability and esthetics success.[/quote]

Notice that you are questioning "soft tissue stability". That is another opportunity for a company to claim design differentiation by making something that no one else wants to make - grooves on the neck of the implant that are not much different than machining score lines. Just look at BioHorizons' ad/link on this website: Touting Laser-Loc by using a quote from Myron Nevins "A true physical connective tissue attachment." If you want to maintain the soft tissue, you need to maintain the hard tissue - one follows the other. Sure you can graft to create a thick piece of tissue to simulate a papilla. Bob James from Loma Linda showed 25 years ago that you get a hemi-desmisomal attachment of soft tissue to titanium, and that was when people worried that an endosseous implant created a pathway of infection into the bone. Branemark showed that if you had the implant projecting through unattached soft tissue, it did not effect bone loss or implant survival so what is a "true physical connective tissue attachment other than a marketing story to create a "unique selling proposition. You can put Nevins up there among the best researchers money can buy. I heard Carl Misch lecture at the AAID meeting in November and he put it well when he said laser-loc was designed to maintain soft tissue. He didn't actually say it did it. An article was published in COIR earlier this year that compared fibroblast attachment to a grooved surface with grooves that were 15u, 30u and 60u. BioHorizons has grooves that in a 2mm band with 12u depth for bone and 8u for soft tissue, as if you could get that half and half band just where you wanted it and the tissue/bone would stay there. At least with micro-threads, you are providing grooves a lot closer to the 60u size and provide additional threaded stability as well. But there are micro-threads and there are micro-threads. They differ in depth and design. What do you not want is micro-threads that cross-thread the bony threads created by the body threads. This can result if the spacing and pitch of the micro-threads do not coordinate with the body threads. The US Patent Office agreed with me that there was one unique combination that eliminated cross-threading while offering the advantages of deeper micro-threads for real bone engagement and double lead body threads for speed of insertion.

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