Marginal bone loss are often encountered after implant insertion. Despite many studies were collected in every stage of implant treatment, main reasons are not still clarified. One of the technical attempts for minimizing the bone loss by reviewing the design of implant-abutment interface. Biological convenience is considered as one of an evaluation criterion for performance of implant-abutment interface.

Bone resorption initiates from the implant insertion. There are many effects presented as surgical traumas, characteristic of implant neck design, location of implant-abutment junction (IAJ), insufficient biological width, high stress levels, occlusal loadings, micromovements of implant and prosthetic parts, micro gap formation between implant and abutment and bacterial contamination [1,2,3]. Especially, bacterial infections following with peri-implantitis are leading to bone loss priorly.

Bacterial leakages occur in the presence of micro gaps between implant-abutment connection (IAC) or micro-movement because of fractured or loosening screws of abutment. These micro gaps are Bacteria contaminated onto the peri- implant area and cause inflammation [4]. According to studies, 1mm of healthy connective tissue resides as biological sealing can prevent this leakage. The formation of biological width is more complex and time taking procedure that starts several weeks after implant procedure. This is also important for building biological tissues near the peri-implant areas. Besides, the tissues can be considered as protective tissues for bacterial groups. According to studies in literature, the filtration of bacterial surrounding, 1 mm of healthy connective tissue is required for biological sealing formation [5]. Although, the necessary biological procedure cannot be existed in first stage of treatment, it is achievable with different IAJ designs especially platform-switching connection.

Platform-switching concept was accidentally found in late 1980s by unavailability of wider diameter abutments for wider diameter implants [3]. In more brief explanation, platform-switching concept is an internal connection combined with a nonmatching implant diameter and a small diameter implant [4]. In addition to this, physical placing of the IAJ is away from the implant and surrounding bone. It assists not only keeping inflammatory cells away but also horizontal extension of the biologic width and diminution in alveolar bone loss reduced the potential influence of micro gap on the crestal bone and decreased stress levels in the peri-implant bone and increases the force in and around the screw [3,6].

Even there are different IAJ mechanisms, platform- switching concept has many superiorities than butt-joint platforms and no interfaced (tissue-level) connections. In one of the studies which was done to compare the platform-switching and without platform-switching implants by Atieh et al. To prevent saucerization and preserve vertical crestal bone, platform-switching ones have more advantages [7]. Another study shows that, even the indications of internal butt-joint connection and Morse- tapper connection with platform switching is nearly same; the difference between crestal bone levels can be identified from the radiographs. The platform- switching Morse- tapper connection implant has better sealing and prevent the micromovements [8].

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References:

[1] Oh, Tae‐Ju, et al. "The causes of early implant bone loss: myth or science?." Journal of periodontology 73.3 (2002): 322-333.
[2] Tatarakis, Nikolaos, et al. "Early implant bone loss: preventable or inevitable?." Implant dentistry 21.5 (2012): 379-386.
[3] Vijayalakshmi, R., and T. Ramakrishnan. "Platform switch dental implants–Search for evidence: An overview." SRM Journal of Research in Dental Sciences 7.2 (2016): 101.
[4] Sasada, Yuya, and David L. Cochran. "Implant-Abutment Connections: A Review of Biologic Consequences and Peri-implantitis Implications." International Journal of Oral & Maxillofacial Implants 32.6 (2017).
[5] Ericsson, I., et al. "Different types of inflammatory reactions in peri‐implant soft tissues." Journal of Clinical Periodontology 22.3 (1995): 255-261.
[6] Zheng, Zheng, et al. "The biological width around implant." Journal of prosthodontic research 65.1 (2021): 11-18.
[7] Atieh, Momen A., Hadeel M. Ibrahim, and Ahmad H. Atieh. "Platform switching for marginal bone preservation around dental implants: a systematic review and meta‐analysis." Journal of periodontology 81.10 (2010): 1350-1366.
[8] Romanos, Georgios E., et al. "Bacterial composition at the implant‐abutment connection under loading in vivo." Clinical implant dentistry and related research 18.1 (2016): 138-145.