Platform Switching

 Interview with Dr. David Gardner (http://www.northshorerid.com) who wrote one of the first papers on platform switching back in 2005 and has lectured extensively on the subject:

“The dynamics involved when an implant is placed are now understood. The crestal bone changes that occur can have a profound effect on treatment outcome and will influence implant location, design, and manufacturer. In addition, restorative options for osseointegrated implants will be greatly influenced by these crestal bone changes. Platform Switching is a way in which the harmful effects of bone remodeling can be decreased and help to ascertain a more predictable outcome thereby improving esthetic expectations.”

Dr. Gardner is highlighting the two major advantages of platform switching:

(1) Esthetics.  If we can better preserve the crestal bone around an implant, then we can better preserve the gingiva as well.  Healthy and plump gingiva, especially papilla, will give us a cosmetic advantage for the final restoration.

(2) Implant Placement Flexibility.  Traditionally implants had to be placed 1.5 millimeters from a natural tooth, 3 millimeters from another implant, and 2 millimeters from the buccal plate in order to compensate for the expected crestal bone loss.  Platform switching preserves bone in all three dimensions: apical-coronal, buccal-lingual, and mesial-distal.  This can give us more flexibility with our implant placement.

So does it work?  Yes.  Numerous papers have been published on platform switching and the results have been confirmed.

Here is an example of a Nobel Active implant replacing an upper right second premolar:

Note the smaller diameter abutment compared to the diameter of the implant platform.

I’m routinely using platform switching in my restorations, especially in the anterior where cosmetics are king.  If you’re interested in trying this out, make sure you are working with a company that allows for platform switching.  You can’t just take a small diameter abutment and expect it to correctly fit a larger diameter implant.  Nobel Biocare and Neoss are two implant companies that I use that have embraced this philosophy.