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Dental Implant Abutments
The other day, we were looking at a case from another office, and wondering why the abutments were much smaller, or stepped back from the dental implant itself.
This was quite an old case , so we know that this was not intentional. But what was so interesting was that there was no bone loss in this case. There are other recent studies that have shown no bone loss with an abutment that was step backed from the implant itself. What does that tell us? Some manufacturers have already been offering these types of abutments for quite some time. Is this the future direction for abutments? Feel free to add your feedback below.
October 17, 2005 in Abutments | Permalink
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I've heard of this but my question is - would this have any affect on the sturdiness of the restoration? In other words, would there be any cause to worry about the abutment fracturing. There are implant companies promoting this "platform switching" but I have reservations. What are other thoughts/concerns on this matter?
Posted by: | Oct 18, 2005 2:19:12 PM
It truely defines the meaning of "horizontal biologic width".
Posted by: Tony Woo | Oct 18, 2005 3:28:22 PM
This procedure is sometimes coined "Platform Switching". This is the intentional (or nonintentional) placement of one size smaller restorative components on the platform of the implant. There are many positive outcomes using this particular technique namely better tissue aesthetics as a result of the preservation of the crestal bone.
Posted by: | Oct 19, 2005 4:11:26 AM
Dr Woo has the key. The biologic width from the gap is still 1.5-2.0 mm. The cell may not know vertical from horizontal. It will keep the distance.
Posted by: Silberg | Oct 19, 2005 6:33:47 AM
The Astra Tech Dental Implant System is essentially a "Platform Switched" prosthetic connection and has extremely favorable bone levels associated with it. However this system has been in clinical use for more than 15 years and was originally designed with a stable prosthetic platform and enhanced bone stability. Personally I have 13 years experience with this system ( over 900 implants in 300 separate clinical cases.)
Posted by: M. Moscovitch | Oct 19, 2005 10:48:46 AM
correct!
Posted by: Silberg | Oct 20, 2005 5:57:55 AM
Modification for the other night. The cells would know vertical vs. horizontal. In any case the biologic width is divided into vertical and horizontal components. The 1.5-2mm is respected..
Posted by: Silberg | Oct 20, 2005 6:17:10 PM
Kudos to Dr. Moscovitch for pointing out that this phenomenon is nothing new. I am amazed that some manufacturers who for many years poo-pooed the bone maintainence qualities of the Astra Tech design have suddenly "discovered" a new abutment arrangement, i.e. platform switching, that seems to maintain crestal bone. One must note, however, that there are additional design elements in the Astra Tech system that contribute to the overall success in bone growth and maintainence as well as tissue health, which are not totally replicated in other systems. I do believe these improvements in other systems will yield better results for patients and that is a good thing. I can, as Dr. Moscovitch did, attest to several years of great results in bone level maintainence and overall success with the Astra Tech system.
Posted by: H. Donatelli | Oct 21, 2005 3:19:59 PM
One thing to also consider about this issue of biological width/length is that connective tissue and junctional epithelium recognizes surface area rather than linear lengths (unlike the human brain...). Thus, one can have a predictable and stable connective tissue seal with a wide transition zone (e.g., 6mm) off an implant and still have the restorative margin be only vertically 0.5mmm off the osseous crest. This is an issue lost on a lot of dentists (and Periodontist) who only focus on the linear height of soft tissue. "Platform Switching" is simply providing the surface area to accomplish this. It is another thing though if this is done at a compromise to the biomechanical strength of the implant-abutment connection. It is critical to use a long interference fit junction for this to be reproducibly created.
Clark Stanford, University of Iowa
Posted by: Clark Stanford | Oct 23, 2005 7:37:49 PM
Clark:
What do you mean by a wide transition zone ie: 6mm off an implant and still be .5mm off the crest of bone?
Posted by: | Oct 24, 2005 7:28:45 PM
The xrays that I have have seen from cases with platform switching have still shown boneloss to the first threads, with the exception of one implant system (ANKYLOS). This implant has a microgap of .71 microns smaller than any bacteria that we know of.
Its not the platform switching its the microgap or lack of that makes the concept of platform work. So what is the microgap in Astra implants?
Posted by: ppatten | Oct 24, 2005 8:34:28 PM
PPaten - you raise the issue - most of the 'discussion' re: 'micro-gap', 'platform switching', etc. is anecdotal and more or less dental implant manufacturer driven. I'm not aware of multiple, long-term studies to substantiate one design over another. The evidence is suggestive, at best.
Posted by: Mark Adams, DDS, MS | Oct 26, 2005 5:16:20 AM
I see there is some interest in these issues surrounding implants with more predictable soft and hard tissue response.As well, implants that incorporate more stable prosthetic platforms and promote biological as well as restorative performance over extended periods of time. Astra Tech is certainly one of these systems with extensive scientific documentation..Dr. Clark Stanford being a significant contributer to this body of knowledge. I think any scientific questions could be directed his way....this system has proved to be the top performer in my practice for 13+ years and I will be glad to field any clinical questions ( most of my answers will be anecdotal, as is most clinical material..but it is still significant if responsibly reported.)
Posted by: Michael Moscovitch | Oct 26, 2005 1:07:39 PM
So which implant systems shows the least crestal bone loss over time? Been having problems with my Branemark implants showing crestal bone loss of 3-4 mm over a 2-5 year period. bone loss stablizes, but is present. Some cases lead to chronic periodontal infections. Ankylos has a lousy prosthetic connection. ITI ? Astra? Frialit? Which system has good prosthetics and the least crestal bone loss?
Posted by: | Nov 18, 2005 11:06:51 AM
This whole notion of platform switching is quite interesting however I have not come across a single study in the literature looking at this specifically (do any exist?). My take is that the biologic width has both vertical and horizontal components and that platform switching essentially "lateralizes" the biologic width thereby minimizing the vertical bone loss traditionally seen with non-platform switched abutments. Hence, the minimal (if any) crestal bone loss seen!
Posted by: Vinay Bhide | Nov 22, 2005 5:01:00 PM
When talking about which system has great prosthetics AND the least amount of crestal bone loss, has anyone mentioned 3i and their new Prevail implant? This implant has all the prosthetic pluses of their internal Certain connection as well as the medialized IAJ. Certainly should be an implant discussed in this blog. I do believe 3i has 10 year radiographs supporting the preservation of crestal bone via platform-switching as well.
Posted by: | Nov 30, 2005 5:01:16 AM
I have placed several of these prevail implants, with mixed results, some showing some bone remodelling akin to a regular threaded implant. I have tried them because I have platform switched routinely for years; this was initially due to not having wide abutments at second stage surgery. I noticed a reduced vertical bone loss. So the jury is still out on prevail. Beware the Ankylos advocates because the placement criteria is different, ie much deeper, so you are starting with more bone coronal to the IAJ.
All interesting stuff, but with an understanding of biological width, you can predict where your bone will finish on most implants.
Posted by: S Jacobs | Nov 30, 2005 8:36:44 AM
I have been using the Astra now as my implant of choice for a while and had superb results. Previously my Nobel biocare experiences were very good, but not quite as precise and fine as the Astra. Ironically, as the first poster started this with, the "offset" was so counterintuitive to me, that I had a negative attitude about it until I understood it more.
I recently looked at the Imtec Endure and at $79 each and with similar features to the astra such as platform switching effect, microthreads, short polished collar, internal connection, etc, I have to ask, why not use it at it's value pricing?
regards
fmn
Posted by: Frank Nelson | Dec 6, 2005 4:49:40 PM
i have used ankylos now for ten years.It is truly a one piece implant with prosthetic versatility.The A implant is what you need to stock the most.This has a 3.5 platform and the standard connection placed 1mm below the crest.The conection is patented and all the big guns like nobel, straUman would love to get there hands on this design-it is a true gapless conection,with a tapered abutment emergence for bundles of soft tissue-sometimes too much- but what a problem to have.It has the connection strenght and platform switch without the increase platform width of the prevail implant-here the platform is too wide and unless the width of the ridge is wide -8mm you will not be able to use it . If the bone isnt wide enough you will just see bone loss-rather like the 4.5 astra st.-its also cheaper- why wouldnt you you make this system your choice in the aesthetic zone
jonathan ziff
Posted by: J. ZIFF | Dec 24, 2005 6:53:37 AM
Platform switching confirms the concept of biologic width that the 1.8mm Straumann collar provides. In addition, the implant system has published studies on SLA that demonstrate long term bone stability. SLA has functional loading earlier than the Astra surface even if nobody follows the guideline and is ahead of TiUnite surface by roughly 6 weeks. Now you can choose a knock off Implant, which gets an also indication from the FDA with if your lucky 1 supporting study, that has been published, the rest of the literature the also companies point to are based on Straumann, Nobel, etc published studies. I have used some knock-offs in my day when playing golf, but the only person who really suffers is me.
Posted by: | Jan 23, 2006 11:05:26 AM
In the late '80's when Nobelpharma came out with their 5mm diameter Branemark implant, there weren't special 5mm platform abutments, so we just used the standard 4.1mm shoulder diameter abutments that were used on the 3.75/4.0mm Branemark fixtures. I have a number of those cases, and they look excellent today. It seems that because of the lack of availability of wide platform parts then, clinical or laboratory error, or intention today, platform switching does work and the biologic width is just as happy on a horizontal surface as a vertical one.
Posted by: Gary D. Kitzis, DMD | Apr 10, 2006 5:13:19 PM
There is one system that has not been discuss, BICON. Vertical bone loss? no more... I've seen many cases that bone grow on the shoulder of the implant.
Posted by: Leonard Nelwan | Apr 15, 2006 11:15:27 AM
I just had my gold coated abutments (front teeth) replaced with ceramic abutments. My dentist says they are excellent, promote a more natural color to the teeth, and they are very strong. Your thoughts?
Thanks,
Diana
Posted by: Diana | May 23, 2006 2:36:55 PM
any studies on ceramic abutments?
Posted by: | May 28, 2006 1:30:21 PM
I am amazed at the misuse of the term "platform switching" in the literature today. Platform switching was the deliberate use of a healing abutment SMALLER than the implant body. After soft tissue maturation, it was switched to the appropriate size. An implant that uses an emergence profile with a NEGATIVE emergence profile is NOT platform switching. Get it right guys!
Posted by: Robert J. Miller | Aug 3, 2006 6:27:05 PM
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