PREVAIL® Articles Summary
1. Chiche F. Espace biologique implantaire et esthétique. Le concept de Platform
Switching. Hors-Série Esthétique 2005;May (France).
The observation that resorption around the implant collar begins when the implant is exposed is a phenomenon
considered to be normal. Platform Switching refers to using prosthetic components that are undersized in relation to
the diameter of the implant platform. The prosthetic connection is displaced towards the center of the implant and this
increases the distance separating the peripheral bone from the base of the abutment. The concept is that the area of
inflammatory connective tissue is medialized and occupies a portion of the implant platform, thereby limiting direct
contact with the crestal bone. The Certain line is an implant system to which Platform Switching can be applied.
2. Gardner DM. Platform Switching as a means to achieving implant esthetics. NY State
Dent J. 2005;71:34-7.
In the case study presented in this article, the technique of Platform Switching was employed to limit both osseous
and soft tissue changes with the result of creating a predictable, aesthetic result. By altering the horizontal position of
the microgap, the horizontal component of bone loss after abutment connection can be reduced and osseous
dimensions maintained. As demonstrated radiographically, the height of bone was maintained after abutment
connection and one year after restoration. Preservation of osseous dimensions led to maintenance of gingival
architecture and pleasing aesthetic results.
3. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on
esthetics. Int J Periodontics Restorative Dent. 2005;25:113-9. ART948
The 3-D bone-to-implant relationship influences soft tissue aesthetics around implants. A certain amount of bone
resorption occurs around implants upon uncovering and contact with the oral environment. Not only is bone volume
on the buccal side of the implant and in the papillary area important, but also the distance between the implant and
the adjacent tooth or implant. Missing bone can be a limiting factor for aesthetics in some cases; in others, it is
possible to regenerate new bone. Clinicians are recommended to focus on the 3-D bone-to-implant relationship to
establish ideal soft tissue aesthetics that are stable over time. One way to achieve platform crestal bone preservation
is by Platform Switching.
4. Baumgarten H, Cocchetto R, Testori T, Meltzer A, Porter S. A new implant design for
crestal bone preservation: initial observations and case report. Pract Proced Aesthet
Dent. 2005;17:735-40. ART961
This article introduces a new implant design: the 3i OSSEOTITE Certain® PREVAIL® Implant, which incorporates
the concept of Platform Switching™. A detailed clinical case was presented demonstrating the benefits of this implant
design in preserving crestal bone and the midfacial and interdental soft tissue in the anterior aesthetic zone.
5. Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for
controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent
2006;26:9-17. ART965
At second-stage surgery, when an implant is uncovered and exposed to the oral environment, a vertical repositioning
of crestal bone occurs. When Implant Innovations Inc. introduced wide-diameter implants in 1991, matching-diameter
prosthetic components were not available. Many of these early 5.0 and 6.0mm wide implants received "standard"
diameter (4.1-mm) healing and prosthetic components. Long-term radiographic follow-up of these “platform-switched"
implants demonstrated a smaller than expected vertical loss of crestal bone height than is typically observed. This
suggests that the inward horizontal repositioning of the outer edge of the implant-abutment interface alters the
biologic process attributed to crestal bone loss.
6. Vela - Nebot X, Rodríguez - Ciurana X, Rodado - Alonso C, Segalà-Torres M. Benefits of
an implant platform modification technique to reduce crestal bone resorption. Implant
Dent 2006; Vol. 15, Nº 3: 313-319.
In this study, abutments of a lesser diameter (4.1mm) than the implant’s platform (5.0mm) were inserted to create a
platform modification. The implants for the test group (30 cases) and the control group (30 cases which received
standard sized abutments) were placed at the same level as the alveolar crest. After abutment attachment the
implants were followed for four to six months to assess bone loss radiographically. The mean value for bone
resorption for the mesial measurement in the control group was 2.56mm and for the study group it was 0.79mm. The
mean bone resorption for the distal measurement in the control group was 2.60mm and 0.84mm for the test group.
7. Calvo Guirado JL, Saez Yuguero MR, Pardo Zamora G, Muñoz Barrio E. Platform
switching with a new implant design. EDI Journal 2006; Vol.2 (2):52-58.
24 Certain Prevail Implants were placed into fresh anterior maxillary extraction sockets (17 central incisors and 7
lateral incisors) and immediately provisionalized. The final prosthesis were placed after 15 days. Mesial and distal
bone height was evaluated the day of placement, at 15 days, 1,2,3, 6 and 8 months after. The mean bone loss in the
central incisors was 0,6mm mesial and 0,8mm distal. In the lateral incisors, the mean bone loss mesial and distal was
0,7mm.
8. Fickl SM, Zuhr O., Wachtel H, Bolz W., Huerzeler M. Periimplant bone level around
implants with platform switched abutments. International Association for Dental Research
Annual Meeting 2006 (Brisbane, Australia), Poster Presentation.
9 patients were treated with fixed implant retained prosthesis including 22 implants. 14 implants were platform
switched and 8 were not. Standardized digital radiographs were taken for evaluation of marginal bone levels at the
time of the installation of the restoration and at 1-year follow-up. Marginal periimplant bone levels were measured at
the mesial and the distal surface of each implant using digital image analysis and digital subtraction radiography.
Results: The mean value of crestal bone height loss at the 1-year follow up was 0.22± 0.06 mm for the platformswitched implants and 1.96 ± 0.4mm for the non-platform-switched implants, and when tested with repeated-measure
ANOVA, the differences were statistically significant (p ≤0.05). Conclusion: The concept of platform-switching
appears to limit the crestal resorption and seems to be able to preserve the periimplant bone levels. The reduction of
the abutment of 0.45 mm on each side (5 mm implant/ 4.1 mm abutment) seems sufficient to avoid periimplant bone
loss.
9. Calvo Guirado JL, Saez Yuguero MR, Pardo Zamora G. Immediate Provisionalization
on a New Implant Design for Esthetic Restoration and Preserving Crestal Bone. Implant
Dent 2007;Vol 16, No.2.
10 Certain Prevail Implants were placed into fresh anterior maxillary extraction sockets (7 central incisors, 3 lateral
incisors) and immediately provisionalized. The final porcelain fused to metal crowns were inserted 24 hours after
implant placement. Mesial and distal bone height was evaluated the day of placement, at 15 days, 1,2,3, and 6
months after. At 6 months the survival rate was 100%. The average mean bone loss measure in the central incisors
was 0.05mm mesial and 0.07mm on the distal. For the lateral incisors the average bone loss mesial was 0.07mm
and distal 0.06mm.
10. Calvo Guirado JL, Saez Yuguero MR, Pardo Zamora G. Immediate Restoration with
Platform Switching in Single Implants for Crestal Bone Preservation. A 12 month
prospective study. (Submitted for publication to IJOMI).
61 Certain Prevail Implants were placed into fresh anterior maxillary extraction sockets (17 central incisors, 12 lateral
incisors, 17 canines and 15 premolars) and immediately provisionalized. The final prosthesis were placed after 15
days. Mesial and distal bone height was evaluated the day of placement, at 15 days, 1,2,3,6,8 and 12 months after.
At 12 months, 2 implants in the premolar region failed giving a survival rate of 96,7%. The average mean bone loss
measure was 0.08mm mesial and 0.09mm on the distal.
11. Rodríguez-Ciurana X, Vela-Nebot X, Segalà-Torres M, Calvo-Guirado JL, Cambra J,
Tarnow D. The Effect of Inter-Implant Distance on the Height of the Inter-Implant Bone
Crest When Using Platform-Switched Implants. (Submitted for publication to IJPRD)
Radiographic studies of bone resorption around 41 pairs of implants placed less than 3 mm apart in 37 patients were
carried out. Vertical and horizontal bone dimensions were measured, and the height of the interproximal bone was
assessed. Results: Mean vertical bone resorption was 0.62 mm, and the mean horizontal component was 0.60 mm.
All the implants were placed less than 3 mm apart, and in two-thirds of the implants pairs, (64%), the crestal bone
peak was preserved. The mean interproximal bone height for all the pairs was 0.24 mm.
Conclusion: Platform-implants design can help us to preserve peri-implant bone and to retain the interproximal bone
peak between two adjacent implants. Due to the fact that this implant design increases bone- implant contact
surface, should be suitable in the use of short implants and atrophic maxilla and jaw.
12. Rodríguez-Ciurana X, Vela-Nebot X, Segalà-Torres M, Rodado-Alonso C, MataBuqueroles M. Biomechanical Repercussions of Bone Resorption Related to Biologic
Width: A Finite-Element Analysis of Three Implant-Abutment Configurations. (Submitted
for publication to IJPRD)
A finite element analysis study was designed to compare the biomechanical response of three types of implantabutment configurations, both before and after establishment of a new biologic width. The three functional units
studied were: a 5mm implant platform connected with an external hexagon to a 5mm-diameter abutment (Type 1), a
5mm implant platform connected with an external hexagon to a 4.1mm-diameter abutment (Type 2), and a 4.8mm
implant platform connected with an internal hexagon to a 4.1mm-diameter abutment (Type 3).
The Type 3 design, which combined platform switching with an internal connection, exhibited the smallest distortions
in stress distribution after bone modelling, and the stress appeared to be distributed over the entire contact surface
most smoothly and uniformly.