ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Platform-Switching Reduces Peri-Implant Marginal Bone Loss and Pocket Depth
Clinical Question For patients receiving dental implants, will a platform-switched implant-abutment connection be more favorable than a regular-platform connection for preserving peri-implant tissue?
Clinical Bottom Line For patients receiving endosseous dental implants, platform-switched implant-abutment connections are more effective than platform-matched connections in reducing peri-implant marginal bone loss and pocket depth. Two recent systematic reviews and meta-analyses of dozens of randomized controlled trials, clinical controlled trials, and case series confirmed these results as statistically significant without any contraindications. Whenever possible, dentists should utilize platform-switching to restore dental implants.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28095526Hsu/201726 studies including 1,087 patients with 2,634 implantsMeta-Analysis
Key resultsOf the included platform-switch vs. regular platform studies, 16 were randomized controlled trials, 5 were controlled clinical trials, and 5 were case series. Meta-analysis indicated that platform-switching significantly (P=.002) reduced peri-implant pocket depth (-0.20 mm), had marginally significant (P=.05) correlation with decreasing vertical marginal bone loss (-0.23 mm), did not significantly (P=.14) affect amount of gingival recession (only evaluated by two studies), and did not (P=.64) impact implant survival rates. Of no significant consequence was whether a flap or flapless surgical technique was used, or whether the platform switch was designed or created by implant-abutment shifting; the relationship between initial tissue thickness and reduction in tissue loss only marginally approached being statistically significant. In general, these studies were found to have high heterogeneity, and a CONSORT quality assessment revealed that only four of studies had a low risk of bias, so authors advised that interpretation of results should be made with caution. Additionally, there are multiple other factors that may influence soft and hard peri-implant tissue outcomes.
#2) 26723496Santiago/201625 studies including 1,098 patients with 2,310 implantsMeta-Analysis
Key resultsOf the included platform-switch vs. regular platform studies, 17 were randomized controlled trials and 8 were controlled prospective studies. Meta-analysis indicated that platform-switching significantly (P<.00001) reduced peri-implant bone loss (-0.41 mm), and did not (P=.75) impact implant survival rates. The authors also found that reduction in peri-implant bone loss with platform-switching was greater in the maxilla (-0.76 mm) than the mandible (-0.29 mm), although both were still statistically significant. The heterogeneity of the studies was low in regards to failed implants but high in regards to marginal bone loss. The Jadad scale (1-5) was used to assess the quality of each included study, and only four of the studies received a score of 4 or 5. The methods employed by the included studies was not uniform, and the results obtained may have been influenced by a host of other factors.
Evidence Search PubMed Search: systematic[sb] AND (platform switching)
Comments on
The Evidence
It may be reasonably asserted that the evidence presented by these two reviews is valid because of the number of randomized controlled trials involving thousands of patients and implants, the appropriate statistical evaluations and meta-analyses, and the proper quality assessments of the individual studies. However, despite achieving statistically significant results, it must be noted that there was high heterogeneity between the individual studies included in the reviews. The evidence shows that dental implant platform-switching reduces marginal bone loss, on average, between 0.23 mm and 0.41 mm. Since these reviews do not present any contraindication to placing platform-switched abutments, platform-switching should be utilized whenever possible.
Applicability Patients receiving dental implants always have at least some risk for developing peri-implantitis. This risk can be easily mitigated, in part, by utilizing a platform-switched implant-abutment connection as it will reduce marginal bone loss and pocket depth. There is no additional cost to provider or patient to implement this concept and no known contraindications.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords platform-switching, dental implant-abutment design, peri-implant tissue, marginal bone loss, pocket depth, gingival recession, implant failure
ID# 3305
Date of submission: 11/28/2017spacer
E-mail nardone@livemail.uthscsa.edu
Author Joshua Nardone, DDS
Co-author(s) Joshua Vess, DMD
Co-author(s) e-mail vess@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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