Q: I noticed on my X-rays that some of the crowns connect to their corresponding implants below with a step, as if the implant is wider than the post connecting the crown, whereas others look flush with the implant, almost like the perfect contours of a light bulb?…Susan from Jupiter.
A: You are very observant! If we ever meet, make sure the lights are dim so as not to show my new goatee with gaps like crop circles created by aliens.
I believe you are talking about “Platform Shifting” in implant restorations. Over the years since the advent of modern dental implants, clinicians had been frustrated with bone loss at the crest of well-placed implants, forming a dished out, or martini-glass-looking “cupping” effect revealed on an X-ray. As if someone took a small garden shovel and dug a mote around the implant. This creates a pocket, which traps more bacteria causing peri-implantitis, which can increase the bone loss leading implant failure.
Lo and behold, the dental nerds discovered that implants have a microscopic seam between the abutment (the stump emanating out of the gum line that holds the crown) and the top of the implant, below the gum line. This “micro gap” traps bacteria in a bad spot that is not cleansable, leading to possible bone loss.
Platform shift allows us to choose a narrower diameter abutment than the implant below, which then moves the micro gap away from the delicate boney area, allowing for better chance for the bone to survive.
Think of it as hiding a seam when you re-upholster your kitchen chairs by wrapping the fabric underneath the cushion and hitting it with a staple gun. You have moved the seam away from the high but-traffic area of the top of the seat. Now your pancakes won’t get caught in any gaps at breakfast.
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