Marginal bone loss around implants with platform switching and platform matched connection: A systematic review

Impact of platform switching implants on crestal bone level: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Despite the widespread success of dental implants, crestal bone loss (CBL) remains a significant challenge, compromising long-term stability and esthetics.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of platform switching in reducing CBL compared with conventional implant designs.

MATERIAL AND METHODS

This systematic review and meta-analysis used primary and alternate search terms (identified through MeSH searching) to retrieve relevant studies published up to April 2024 from global databases, including PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov. The random-effects model was applied to calculate the weighted mean differences (WMD) and 95% confidence interval (95% CI) of the CBL for the meta-analysis. The quality of the included studies was assessed with the Cochrane Risk of Bias Tool (RoB 2).

RESULTS

The meta-analysis revealed that the platform-switching technique significantly reduced CBL compared with conventional implant designs. On average, implants with platform switching showed a 0.22-mm reduction in CBL (WMD=-0.22; 95% CI=-0.39, -0.05; I²=58.18%; Pheterogeneity=.069). Subgroup analyses indicated that this reduction was most pronounced for single implants (WMD=-0.42; 95% CI=-0.49, -0.35) and at the posterior mandible site (WMD=-0.48; 95% CI=-1.11, -0.15). Conventional loading restorations also showed a greater decrease in CBL compared with immediate and functional loading (WMD=-0.33 versus -0.06 and -0.08). Additionally, longer follow-up periods beyond 36 months resulted in a more substantial reduction in CBL (WMD=-0.50; 95% CI=-0.55, -0.45).

CONCLUSIONS

These findings support the use of platform switching as a strategy to enhance implant stability and long-term outcomes, highlighting its potential for improving clinical practices in implant dentistry. Further research is recommended to confirm these benefits and explore the underlying mechanisms.

Optimizing implant osseointegration, soft tissue responses, and bacterial inhibition: A comprehensive narrative review on the multifaceted approach of the UV photofunctionalization of titanium

Titanium implants have revolutionized restorative and reconstructive therapy, yet achieving optimal osseointegration and ensuring long-term implant success remain persistent challenges. In this review, we explore a cutting-edge approach to enhancing implant properties: ultraviolet (UV) photofunctionalization. By harnessing UV energy, photofunctionalization rejuvenates aging implants, leveraging and often surpassing the intrinsic potential of titanium materials. The primary aim of this narrative review is to offer an updated perspective on the advancements made in the field, providing a comprehensive overview of recent findings and exploring the relationship between UV-induced physicochemical alterations and cellular responses. There is now compelling evidence of significant transformations in titanium surface chemistry induced by photofunctionalization, transitioning from hydrocarbon-rich to carbon pellicle-free surfaces, generating superhydrophilic surfaces, and modulating the electrostatic properties. These changes are closely associated with improved cellular attachment, spreading, proliferation, differentiation, and, ultimately, osseointegration. Additionally, we discuss clinical studies demonstrating the efficacy of UV photofunctionalization in accelerating and enhancing the osseointegration of dental implants. Furthermore, we delve into recent advancements, including the development of one-minute vacuum UV (VUV) photofunctionalization, which addresses the limitations of conventional UV methods as well as the newly discovered functions of photofunctionalization in modulating soft tissue and bacterial interfaces. By elucidating the intricate relationship between surface science and biology, this body of research lays the groundwork for innovative strategies aimed at enhancing the clinical performance of titanium implants, marking a new era in implantology.

The influence of platform switching and platform matching on marginal bone loss in immediately inserted dental implants: a retrospective clinical study

PURPOSE

The aim of this retrospective study was to investigate and compare the effects of platform switching (PS) and platform matching (PM) on marginal bone loss (MBL) and clinical parameters in immediately inserted dental implants.

METHODS

Thirty-seven patients were included (PS group: twenty-one patients, PM group: sixteen patients), with follow-up periods ranging from six months to 23 years. MBL was measured using orthopantomograms (OPG), and implant success was evaluated using the Buser, Albrektsson, and Attia criteria. Regression analysis was conducted to assess total bone loss.

RESULTS

The BEGO RI implant system was used in 83.8% of cases. Mesial MBL averaged 0.26 mm in the PS group and 0.75 mm in the PM group, while distal MBL was 0.68 mm for the PS group and 0.53 mm for the PM group. A significant difference was observed in mesial MBL, with the PS group showing less bone loss (p. = 0.044). Regression analysis indicated that PM implants were associated with significantly greater mesial bone loss compared to PS implants (p. = 0.039). No significant differences in implant success were observed between the PS and PM groups based on the Buser score, Albrektsson criteria, and Attia score.

CONCLUSION

Both PS and PM implants showed comparable long-term functionality. No significant differences were found in total bone loss between the groups, but PS implants showed significantly lower mesial MBL. While both systems are viable for immediate implantation, PS implants may offer advantages in preserving peri-implant bone. Further prospective studies are needed to validate these findings.

The impact of a 1 mm interimplant distance on the interproximal crestal bone height: a case report with a 10-year follow-up and literature review

BACKGROUND

Between adjacent dental implants, an interimplant distance (IID) of at least 3 mm has been recommended to avoid resorbing the interproximal crestal bone. The effect of a 2 mm IID on crestal bone loss has been investigated but the literature is scarce when it comes to an IID of 1 mm. There is a need to document such clinical situations when they occur and elucidate if such a narrow IID is deleterious or not to the interproximal crest. The present case deals with an IID of 1 mm in the premolar area where, for the first time, the fate of an interimplant crest is reported after a 10-year follow-up.

CASE PRESENTATION

A 57-year-old patient attended with 2 hopeless maxillary premolars. The mesio-distal space available for implant rehabilitation was too narrow to receive standard diameter implants and keep an inter-implant distance (IID) of 3 mm as recommended by accepted guidelines. A protocol of immediate implant placement and provisionalization involving 2 implants of Ø 3.5 mm was implemented; placement in the extraction sockets resulted in an IID of 1 mm. After 3 months of healing the final prosthesis was delivered; the patient has been followed for 10 years now. Surprisingly, the findings showed that the interimplant crest was maintained 1.40 mm coronal to the shoulder of the neck of the implants. Bone completely filled the space between the prosthetic concave abutments and the interproximal papilla was closing the embrasure. The literature reports only 2 experimental studies involving a 1 mm IID; both showed that this did not lead to the resorption of the interproximal bone.

CONCLUSIONS

Unexpectedly, the present case with an IID of 1 mm did not lead to the resorption of the interproximal bone after 10 years. It is speculated that the reason for that is due to the implants displaying an internal conical connection, the platform-switching feature, concave abutments and subcrestal placement. The fate of the interproximal crest of implants placed with an IID of 1 mm lacks scientific evidence. More studies are warranted to elucidate this question in order to propose the best implant treatment in cases displaying a limited mesio-distal space.

Protein profile at newly restored implants compared to contralateral teeth over 12-months: a pilot study

OBJECTIVES

To determine crevicular fluid alterations in protein expression of newly restored implants during their first year of function and associate them with those of contralateral teeth.

MATERIALS AND METHODS

In ten non-smokers, successfully treated for periodontitis, one newly restored implant (baseline-T0) and one corresponding tooth were followed for 12-months (T1). Oral hygiene was monitored during the study. Periodontal clinical indices and crevicular fluid were collected from an implant-site (PICF) and a tooth-site (GCF). Total proteomic profiles of PICF and GCF were investigated using label-free quantitative proteomics.

RESULTS

Clinical recordings remained stable at 12-months on the tooth-/implant-site basis. The comparative analysis of protein enrichment between teeth and implants at T0 revealed 664 human proteins, with 93 found only in teeth and 217 exclusively in implants. Among the 354 overlapping proteins, 46 were upregulated (log2FC > 1) in teeth, while 61 in implants. At T1, 569 human proteins were exclusively identified, with 67 found only in teeth and 193 exclusively in implants. Of the 309 overlapping proteins, 22 were upregulated in teeth, while 48 were in implants. The over-representation enrichment analysis identified "interferon-alpha response" and "allograft rejection" pathways, as significantly regulated categories at T0, with the latter being over-represented at T1.

CONCLUSIONS

Peri-implant tissue maturation was evident during the study. Proteins expressed in crevicular fluid reflected unique patterns between implants and teeth that are worth studying.

CLINICAL RELEVANCE

Different proteomic patterns were observed at the implant-site compared to the contralateral tooth-site towards inflammatory processes that prevail within otherwise clinically healthy peri-implant tissues.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID: NCT06379022.

Immediate Loading Full-Arch 3D-Printed Implant-Supported Fixed Rehabilitation: A Case Report with 24-Month Follow-Up

Implant-supported immediate loading full-arch rehabilitation has been documented in the literature. More recently, computed surgical guides have frequently been used since they facilitate planning and performing surgical treatment without the need to raise a flap, thus reducing trauma and morbidity. This case report describes an immediate full-arch, fixed rehabilitation with full loading placed on four commercially available 3D-printed implants, with a 24-month follow-up. The implants were placed with the help of a digitally planned 3D-printed surgical guide. The provisional fixed prosthesis installed immediately was replaced after 3 months. At the time, the soft and hard tissue around the implants appeared stable, without signs of inflammation. The same situation was observed at the 24-month follow-up. Three-dimensional-printed implants seem to be a promising choice in this case. However, further clinical studies with longer follow-up periods are necessary to confirm their efficacy.

An introduction to dental implants

The use of implants to replace missing teeth is now commonplace and practised by clinicians worldwide in both general and specialist practice. There is an abundance of evidence on the general success of implant treatment. As well as reviewing the history of dental implants, this narrative review will discuss the merits and successful placement of tissue-level verses bone-level implants. Furthermore, the article will evaluate the concept and benefits of platform switching for implant treatment. Finally, with the increased placement of implants, this narrative paper will review how different titanium surfaces impact on the risk of peri-implantitis.

Breakthroughs in Oral and Maxillofacial Surgery

In the field of oral and maxillofacial surgery, continuous advances have ushered in a new era of innovation, profoundly influencing this branch of medicine [...].

Comparative evaluation of hard and soft tissue parameters by using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla

Objective

The objective is to compare and evaluate the hard and soft tissue parameters by using short and standard long implants with sinus lifting in the posterior maxilla.

Materials and Methods

Eleven patients with complaints of missing upper back teeth were enrolled in the study for implant-supported rehabilitation and were categorized into two groups: Group long (GL): longer implant (>8 mm) placement, preceded by Sinus Augmentation. Group short (GS): short implant (≤8 mm) placement, without sinus augmentation. The primary outcome measured was cumulative survival rate (CSR) in the compromised partial edentulous posterior maxilla. Secondary outcomes measured were implant stability (IS), marginal bone level alterations (MBL), pocket probing depth (PPD), crown-to-implant ratio, and any complications.

Results

The difference in CSR between the groups was not statistically significant (P = 0.317). High stability was achieved immediately after the placement of the implants, in both groups (GS: 64 ± 4.07, GL: 65.58 ± 9.75); this difference in the mean ISQ (IS quotients) values was not found to be statistically significant at implant placement (P = 0.7). The mean MBL reported in the study at the end of 12 months of prosthesis function was - 0.762 ± 0.48 mm and - 0.7 ± 0.34 mm for GS and GL, respectively. The mean PPD measurements in GS and GL groups were 1.917 ± 0.68 mm and 1.833 ± 0.38 mm, respectively, and it was not statistically significant (P = 0.8).

Conclusion

Within the limitations of the present study, the obtained results indicate that short implants provided a similar clinical and radiographic performance compared to long implants placed in combination with a sinus augmentation procedure (lateral window) up to 12 months after prosthetic loading.

Conometric Connection for Implant-Supported Crowns: A Prospective Clinical Cohort Study

BACKGROUND

Traditional screw or cemented connections in dental implants present limitations, prompting the exploration of alternative methods. This study assesses the clinical outcomes of single crowns and fixed partial prostheses supported by conometric connections after one year of follow-up.

METHODS

Twenty-two patients received 70 implants, supporting 33 rehabilitations. Biological responses and prosthodontic complications were evaluated at baseline, 6 months, and 12 months.

RESULTS

All implants exhibited successful osseointegration, with no losses or peri-implant inflammation. Marginal bone levels showed minimal changes, well below pathological thresholds. The difference in marginal bone loss (MBL) was -0.27 ± 0.79 mm between T0 and T1, and -0.51 ± 0.93 mm between T0 and T2. No abutment screw loosening or crown chipping occurred. However, coupling stability loss was observed in nine cases.

CONCLUSIONS

The conometric connection demonstrated successful integration and minimal complications after one year. This alternative shows promise, particularly in simplifying handling and improving marginal adaptation. Further research with larger sample sizes and longer follow-up is warranted for comprehensive validation.