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    • br Conclusion br Introduction Since Br

    2018-10-29


    Conclusion
    Introduction Since Brånemark found that osseointegration occurred between titanium and bone in the mid-1960s, dental implants were introduced for the replacement of missing teeth, and treatment options for the partially or fully edentulous patient have expanded exponentially [1]. The healing following implant installation of various systems has been documented in a variety of clinical studies. The quality and chemicals i was reading this of the soft tissue interface with implants and abutments together with crestal bone preservation are most likely of paramount importance for the short and long-term prognosis of oral implants [2]. Albrektsson et al. [3] found that the installation of two-piece implants healing in a submerged modality resulted in a crestal bone loss of 1.5–2.0 mm after 1 year of loading. Moreover, in experimental studies in dogs, a crestal bone remodeling with a resorption of 2 mm has been verified. Clinicians, researchers, and implant companies have, thus, dedicated time to finding ways to control the crestal bone loss that occurs after abutment connection. One approach [4] has focused on controlling or decreasing the horizontal component of the bone loss by a technique known as platform switching; which refers to the use of a smaller diameter abutment on a larger diameter implant collar. Such a connection shifts the perimeter of the implant-abutment junction inward toward the central axis of the implant. Canullo et al. [5] this prosthetic concept has been introduced as ‘platform switching’ and radiographic follow-up has demonstrated a smaller than expected vertical change in the crestal bone height around implants. Using three-dimensional finite-element models, Maeda et al. [6], examined the possible biomechanical advantage of platform switching in an in vitro study and suggested that by this configuration, the stress concentration would be shifted away from the cervical bone–implant interface. The ability to reduce or eliminate crestal bone loss would be a major achievement in implant dentistry. Hürzeler et al. [7], Clinical benefits such as superior esthetics (particularly for adjacent implant sites), better bone to implant contact and improved primary stability, could be obtained. The purpose of this clinical trial was to show that the crestal bone height around dental implants could be influenced by using a platform switch protocol.
    Materials and methods
    Results
    Discussion In the current study, over a period of almost a year, it could be demonstrated that implants restored according to the platform-switching concept experienced significantly less marginal bone loss than implants with matching implant–abutment diameters (see Table 2). The etiology of bone remodeling, was believed to be dependant on the localized inflammation of the peri-implant soft tissue [8]. This view was been supported, especially in view of the micro gap at the implant abutment junction inflammatory cell infiltrate of the abutment, where it is always possible to detect bacterial infiltration, as reported by Jensen et al. (1997) [9]. This infiltrate was extended vertically for about 0.5–0.75 mm coronal to the IAJ and 0.5–0.75 apical to the IAJ. The ICT never ended in contact with the bone but was separated from it by an approximately 1 mm wide layer of healthy connective tissue. The study of, Hermann et al. (1997) [10] observed radiographically that an initial bone loss of 1.5 occurred around implants, and the level then stabilized. These results indicate that biologic distances are established at the implant-gingival junction, which is accordance with other studies. More recently, Warren et al. (2002) [11] reported that crestal bone resorption of 1.0–1.5 mm may occur almost immediately after implant loading. These findings are in accordance with the results of other authors Weng D et al. (2008) [12]. The platform switching concept is a recent approach which focused on controlling or decreasing the horizontal component of the bone loss; it refers to the use of a smaller diameter abutment on a larger diameter implant platform. Such a connection shifts the perimeter of the implant-abutment junction inward toward the central axis of the implant to preserve marginal bone from stress concentration. It is also believed that inward movement of IAJ shifts the inflammatory cell infiltration to the central axis of the implant and away from the adjacent crestal bone which is thought to restrict crestal bone resorption [13]. Moreover, crestal bone loss and soft tissue stability are influenced by the abutment collar length which controls the final crown margin location and the subsequent esthetic outcome.