Platform switching minimises crestal bone loss around dental implants: truth or myth?

The aim was to assess the role of platform switching (PS) in minimising crestal bone loss around dental implants through a systematic review of the currently available clinical evidence. To address the focused question 'Does PS minimise crestal bone loss compared with non-platform-switched (NPS) implants?', PubMed/Medline and Google Scholar databases were explored from 1986 up to and including December 2013 using the following key words in different combinations: 'bone loss', 'dental implant', 'diameter', 'mandible', 'maxilla' and 'platform switching'. Letters to the Editor, unpublished data, historical reviews, case reports and articles published in languages other than English were excluded. Fifteen clinical studies were included. In seven studies, PS and NPS implants were placed in both the maxilla and mandible. In 13 studies, implants were placed at crestal bone levels whereas in one study, implants were placed supracrestally. Three studies reported the bucco-lingual (or transversal) width of the alveolar ridge which ranged between 7-8 mm. Seven studies reported that implants placed according to the PS concept did not minimise crestal bone loss as compared with NPS implants. 3D-Implant positioning, width of alveolar ridge and control of micromotion at the implant-abutment interface are the more critical factors that influence crestal bone levels than PS.