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Within the realm of prosthodontics, the challenge of replacing multiple missing teeth is a complex one, compounded by patient's preference for fixed prostheses over removable ones owing to their superior aesthetic and functional attributes. However, the feasibility of fixed prostheses diminishes in scenarios marked by compromised remaining dentition and defects in edentulous regions. To navigate these challenges effectively, the Andrew's bridge emerges as a compelling solution, integrating both fixed and removable components. This approach, particularly adept at addressing extensive alveolar bone defects, offers a synthesis of advantages including enhanced phonetics, hygiene, aesthetics and function. This article details a case report that outlines the digital fabrication process of an Andrews Bridge used to treat a maxillary anterior ridge defect.
RESUMO
STATEMENT OF PROBLEM: Platform switching using narrower abutments than the implant platform has been used to reduce marginal bone loss (MBL) surrounding dental implants. While platform switching has been reported to prevent initial peri-implant bone loss, available data regarding the use of the platform-switching implant abutment configuration with long-term follow-up has been sparse; thus, the systematic review was planned to evaluate the best available evidence for the use of the platform switching technique. PURPOSE: The purpose of this systematic review was to answer the specific question, "Is there a difference between platform-matching implant abutment configurations and platform-switching implant abutment configurations in terms of MBL changes around endosseous implants"? MATERIAL AND METHODS: The PubMed/Medline, Scopus, Google Scholar, and Lilac databases were searched by 2 independent reviewers for articles published between January 2000 and July 2022. Platform-switched versus platform-matched implants were examined for changes in MBL in human randomized clinical trials (RCTs) and potential clinically controlled cohort studies (PCCS). RESULTS: Overall, 4 eligible studies were included and critically evaluated to summarize their findings. The follow-up period of the included studies was between 5 and 10 years. Two of the included studies showed a mean ±standard deviation of 0.6 ±0.20 mm MBL at 5 years and 1.20 ±0.21 mm at 10 years for the platform switched (PS) technique and 1.1 ±0.3 mm and 1.24 ±0.39 mm MBL for the platform matched (PM) technique. Another study showed marginal bone level changes for the platform-switched technique to be 0.18 ±0.14 mm as compared with the platform matched technique (0.80 ±0.40 mm). In one of the studies published in 2019, the mean estimated difference in the marginal bone levels of PS- and PM-restored implants after 5 years was reported to be 0.29 mm. The descriptive analysis of 4 RCTs indicated that platform-switched implant-to-abutment connections reduced average marginal bone loss surrounding implants compared with platform-matched implant-to-abutment connections, favoring the platform-switched approach. CONCLUSIONS: Platform switching appears to be a beneficial approach for retaining the crestal bone around dental implants.