JIACD
The Journal of Implant & Advanced Clinical Dentistry
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Thanks Dr. Herndon
Very good answer and one hopefully people will learn from. I enjoy reading your comments as you have a wealth of experience.
Platform Switching: A question for Dr. Herndon on cement problem
Great answer on Platform switching Michael. Once issue I am seeing on my side of the world is cement leading to bone loss around the implant.
Are you seeing this in your practice? What are you recommending to your colleagues to avoid this?
Its a big problem.
For Dr. Chace Heatly... answer?
I am sorry, Dr. Heatly.. I just now say your post and question!
Cement issues around implants are really due only to inattention to clean up after cementing.. not to be redundant, but that is the truth. Avoiding it is as simple as making sure all the cement is removed.. again a redundant answer... but that is also the truth.
So, how do you do it? The first thing is to make your margins in accessible positions.. not deep under the tissue. If one finds oneself with deeper margins, then these areas MUST be cleaned.. Blow air under the tissue and evaluate, get the patient numb and go for it, do whatever it takes to make sure it is all gone.
In a referral situation, bring the patient in post cementation and evaluate it yourself to make sure. This is the key... you have to make sure yourself, don't just depend on the other dentist unless you are completely sure of their expertise. In the unfortunate event that you cannot get access, flap and remove. But margin position is really the key.
The other comment that states that to avoid cement problems by using screw retained prosthetics sure solves the problem! (but it does not answer the question!)
Michael
Easy way to deal with implant cement problems
Here is a simple way to avoid implant cement problems:
Use a screw retained crown!
Thank you, thank you. I will be here all week. Try the veal!
Platform switching can be helpful on teeth as well as implants!
The concept behind platform switching is related to the fact that Biologic Width is not a vertical requirement, but a distance requirement whether it be vertical, horizontal, or anything in between. Since Biologic Width is a phenomenon of tissue requiring space to behave (heal) naturally, one can use this concept on teeth as well as implants. For example, in a case of cuspal fracture that extends subgingival to a degree that the BW is invaded, Crown lengthening surgery is usually required to create a new BW apically to allow reconstruction of lost tooth structure without invasion of the BW and subsequent iatrogenic periodontitis.
In this example, if one imagines the BW to be a space requirement rather than a vertical measurement, you can reduce the extent (or even eliminate) of ostectomy required by adjusting the fractured portion of the tooth (odontoplasty) and placing the final margin coronal to the apical extent of the fracture. With the restorative concepts and abilities of adhesive dentistry (read dentin bonding) today, one can reduce or eliminate the need for a ferrule for retention and thereby even further reduce the extent or need for ostectomy.
This is an important concept in today's world of protecting bone levels as we practice. This is just simply taking the concept of Platform Switching, understanding the biological reasons for it, and applying it creatively for the benefit of the patient.
Just another application of this concept.
Platform switching Not sure it makes a difference
I have platformed switched implants and I am not sure it makes a difference. Anyone know any long term studies?
3i provide implant platform switch
I been using the provide platformed switched implant by 3i and I definetly see a difference. I been using it for two years now. Just my clinical experience to back it up at this point.