Biomechanical effect of platform switching in implant dentistry : a

three-dimensional finite element analysis

Chih-Ling Chang Chen-Sheng Chen Ming-Lun Hsu

Chih-Ling Chang, D.D.S. M.S.

Graduate student
Department of Dentistry
National Yang-Ming University
Visiting Doctor
Dental Department
Shin Kong Wu Ho-Su Memorial Hospital

Chen-Sheng Chen, Ph.D.

Associate Professor
Department of Physical Therapy and Assistive Technology
National Yang-Ming University

Ming-Lun Hsu, D.D.S. Dr. Med. Dent.

Associate Professor, Chairman
Department of Dentistry
National Yang-Ming University

Corresponding author:
Ming-Lun Hsu D.D.S. Dr. Med. Dent.
Associate Professor, Chairman
Department of Dentistry
National Yang-Ming University
No.155, Sec.2, Li-Non Street, Taipei, Taiwan
Tel: +886-2-28267031
Fax: +886-2-28201074
E-mail: mlhsu@ym.edu.tw
Biomechanical effect of platform switching in implant dentistry : a

three-dimensional finite element analysis

ABSTRACT

Purpose: The purpose of this study was to analyze and compare the implant-bone
interface stresses in anisotropic three-dimensional finite element (FE) models of an
osseointegrated implant with platform switching and conventional matching-diameter
implant platform and abutment in the posterior maxilla. Materials and Methods:
Three-dimensional FE models were created of a first molar section of the maxilla and
embedded with a single endosseous implant (4.1 x 10 mm). One model simulated a
4.1 mm diameter abutment connection and the other was a narrower 3.4 mm abutment
connection assuming a platform switching configuration. A gold alloy crown with
2-mm occlusal thickness was applied over the titanium abutment. Material properties
of compact and cancellous bone were modeled as fully orthotropy and transversely
isotropy respectively. Oblique (200-N vertical and 40-N horizontal) occlusal loading
was applied and perfect bonding was assumed at all interfaces. Results: Maximum
von-Mises stress, compressive and tensile stresses in compact bone were lower in the
platform switching model than in the conventional model. However, the maximum
von-Mises stress in cancellous bone was higher in the platform switching model than
in the conventional model. Conclusion: Platform switching technique was able to
reduce the stress concentration in the area of compact bone and shift it to the area of
cancellous bone during oblique load.
Key words: finite element analysis, orthotropy, platform switching, stress,
transversely isotropy.

INTRODUCTION

The observation of alveolar bone resorption that occurs around a 2-piece implant
following abutment attachment has been well-documented1,2. Such remodeling does
not typically occur as long as the implant remains completely submerged, but rather
develops when an abutment is connected during second-stage surgery, when a
two-stage implant is placed and connected to an abutment in a one-stage procedure, or
when an implant is prematurely exposed to the oral environment and bacteria3. Crestal
bone levels are typically located approximately 1.5 to 2.0 mm below the

1
implant-abutment junction (IAJ) at one year following implant restoration4. This
position appears to be constant, regardless of where the IAJ is situated relative to the
original level of the bony crest5. Several theories exist as to the reason for the
observed changes in crestal bone height following implant restoration. The
radiographic observation that postrestorative “ remodeled”crestal bone generally
coincides with the level of the first thread on most standard implants has led some
authors to suggest that when dental implants are placed into function, crestal bone
remodels as a result of stress concentration at the coronal region of the implant6,7.
Other authors found histologic evidence of inflammatory cell infiltrate associated with
a 1-mm- to 1.5-mm-tall zone adjacent to the IAJ8 and crestal bone remodeling is a
result of localized inflammation within the soft tissue located at the implant-abutment
interface9. Approximately 3 mm of peri-implant mucosa is required to create a
mucosal barrier around the top of the dental implant10. Bouri stated increased width
of keratinized mucosa (≥2mm) around implants might be associated with lower mean
alveolar bone loss and improved indices of soft tissue health11. This suggests that
crestal bone remodeling may occur to create space when inadequate soft tissue height
is present so that a biological seal can be established, which will isolate the crestal
bone and protect it from the oral environment12. There is still insufficient reliable
evidence to provide recommendations on whether techniques to correct/augment
peri-implant soft tissues or to increase the width of keratinized/attached mucosa are
beneficial to patients or not13.

The concept of “ platform switching”refers to the use of a smaller-diameter

abutment on a larger-diameter implant collar; this connection shifts the perimeter of
the IAJ inward toward the central axis of the implant and also repositions the
inflammatory cell infiltrate and confined it within a 90˚area that was not directly
adjacent to the crestal bone, which limits the bone change that occurs around the
coronal aspect3. In 1991, implant innovations introduced wide-diameter implants with
matching wide-diameter platforms. At the time of introduction of the wide-diameter
implants, no matching, similarly dimensioned prosthetic components were available.
Hence, clinicians restored them with standard 4.1-mm abutments. After a 13-year
period, the typical pattern of crestal resorption was not observed radiographically in
cases where platform switching was utilized3. Studies have also demonstrated a
significant reduction in bone loss occurred in all those cases in which the platform
geometry was modified, as compared with the control group for which
matching-diameter implant platforms and abutments were used14. The mean value of
bone resorption observed in the mesial and distal measurement for the control group
was 2.53 mm and 2.56 mm respectively, whereas for those patients included in the

2
study group, it was 0.76 mm and 0.77 mm. The possible reasons for bone preservation
with the platform switching have also included the alteration of the micro-gap
location or the stress concentration area between the implant and bone. This has not
yet been clarified15. The purpose of this study was to analyze and compare the
implant-bone interface stresses in anisotropic three-dimensional finite element (FE)
models of an osseointegrated implant with platform switching and conventional
matching-diameter implant platform and abutment in the posterior maxilla.

MATERIALS AND METHODS

FE model design
Computerized tomographic images of a human edentulous maxillary first molar
area exhibiting buccal bone irregularities were acquired. The maxilla was
approximately 11 mm in width bucco-lingually and 13 mm in height infero-superiorly.
The cross-sectional image was then extruded to create a three-dimensional section of
maxilla 6.5 mm in length in the mesio-distal direction. Due to symmetry with respect
to the bucco-lingual plane in the geometry and loading, only half of the FE model
needed to be considered16. The implant was embedded in the maxillary right first
molar area and a gold alloy crown with 2-mm occlusal thickness was applied over the
titanium abutment. The overall dimensions of the crown were 8.5 mm in height, 10.6
mm in buccolingual width and mesiodistal length. Although porcelain is often the
choice for implant superstructure, a gold alloy was simulated in this study because
previous study showed no difference in the bone and implant stresses between these
materials17. The maxillary segment with an implant, abutment and a superstructure
was modeled using a 3-D FE software ANSYS 11.0 (Swanson analysis system,
ANSYS, Canonsburg, PA). The mesial and distal section planes were not covered by
compact bone. The geometry of the 10-mm OSSEOTITER CertainR implant (3i
Implant Innovations, Inc., Palm Beach Gardens, Fl) was used as a reference to model
a threaded implant. One FE model simulated a 4.1 mm diameter and a 5-mm-high
abutment (GINGIHUER POST, 3i Palm Beach Gardens, Fl) connection (conventional
model) and composed of 47408 nodes and 194,978 elements. The other FE model
simulated a 3.4 mm diameter and a 5-mm-high abutment (GINGIHUER POST, 3i Palm
Beach Gardens, Fl) connection assuming a platform switching configuration (platform
switching model) and composed of 45782 nodes and 194,240 elements (Fig 1).
Because of the mesiodistal symmetry, only half of the model was meshed with the
method of sweep with 20-node-hexahedron elements between the thread and

3
cancellous bone and 10-node-tetrahedron mesh in compact bone and crown (Fig 1).

Material properties
The implant and gold alloy crown used in the models were considered to be isotropic,
homogenous, and linearly elastic. The elastic properties were adopted from the
literature, as shown in Table 1. To obtain a more realistic simulation, the anisotropic
material properties of compact and cancellous bone were considered in this FE model
as listed in Table 2.
Interface conditions
The bone-implant interface was assumed to be perfect, simulating 100%
osseointegration, and the crown, abutment, and implant were assumed to be complete
bonded without any loosening.

Loading and boundary condition

Since only half of the model was meshed, symmetry boundary conditions were
prescribed at the nodes on the symmetry plane. Models were constrained in all
directions at the nodes on the mesial bone surface. Because of symmetry conditions,
these constraints were also reproduced on the distal bone surface.
Loading was simulated by applying an oblique load (vertical load of 100 N and
horizontal load of 20 N) from buccal to palatal to four different locations. Because a
symmetric half model was used, this is equivalent to a load of 200 N in the vertical
and 40 N in the buccal-palatal direction18,19. Loading locations were applied on the
central and distal fossa of the crown20,21(Fig 2).
The FE model was used to calculate the von Mises stress. However, the bone
sometimes can be classified as brittle material, so the principal stress is also
implemented to evaluate the situation of compact bone surrounding the implants.
Additionally, stress distributions in the FE models were illustrated to compare the
biomechanical effect between the conventional model and platform switching model.

RESULTS

Maximum equivalent stress

Compact bone
Compared with cancellous bone, substantial stress was observed in compact bone.
Under oblique loading from buccal to palatal, more apparent stress concentration in
the compact bone was observed on the palatal side of the platform of the implant in
the conventional model. The maximum von Mises stress in the compact bone was

4
higher in the conventional model (89.2MPa) than in the platform switching model
(84.3MPa). The maximum von Mises stresses of both models were found adjacent to
the first thread of the implant near the junction of compact and cancellous bone (Fig
3).
The von Mises stresses of each nodes are shown as a continuous line in three
different levels (Fig 4). The first level is the compact bone surrounding the platform
of the implant and the value of the stress gradually increased from the buccal to the
palatal side in the conventional model. The second level is the transitional area
between the platform and first thread of the implant and stress distribution appeared to
vary less between both models. The third level is the junction between compact and
cancellous bone and stress distribution showed consistent pattern with the first level in
the conventional model.
Cancellous bone
The maximum von Mises stress in cancellous bone was higher in the platform
switching model (33.6MPa) than in the conventional model (18.4MPa). The
maximum von Mises stresses of the both models were found near the apical area of
the implant (Fig 5). The apparent stress distribution shows not only the palatal side of
the platform and the apical area of the implant but also along the entire surface of the
thread in the platform switching model.
Principal stress in compact bone surrounding implant
The compact bone bent in a manner analogous to the bending of an elastic plate, and
the interface stress was compressive along the top half of the compact bone and
tensile along the bottom half due to the buccal-palatal load (Fig 6). Peak values of
peri-implants tensile stress in compact bone is 130.6 MPa for conventional model and
98.8 MPa for platform switching model. Peak values of peri-implants compressive
stress in compact bone is -69.4 MPa for conventional model and -30.1 MPa for
platform switching model (Fig 7). Conventional model increased the 3rd principal
stress in tension by 136.4% and in compression by 130.6% obviously. But for the 1st
principal stress in compression, the value decreased by 41.7%, and all of the data
demonstrated in Table 3.

DISCUSSION

Biological and clinical implications

Bone resorption close to the first thread of osseointegrated implants is frequently
observed during initial loading. To achieve stable osseointegration for implant
restoration, the generation of high stress concentration or distribution in bone should

5
be avoided, since the high level of stress concentration or distribution can induce
severe resorption in the surrounding bone2,22-25, leading to gradual loosening and,
finally, complete loss of the implant. Crestal bone loss at the implant neck area,
however, is not inevitable because some clinical observations have presented that less
bone resorption with bone preservation is possible when the smaller diameter of
abutment is connected to the implant, so called platform switching3,15,26-28. The
possible reasons for bone preservation with the platform switching technique have
also included the alteration of the location of the implant-abutment junction (IAJ) or
the stress concentration area between the implant and bone. According to the results
of the present study indicated that maximum von Mises stress in compact bone was
lower in the platform switching model (84.3MPa) than in the conventional model
(89.2MPa) occurred mainly at the palatal surfaces of compact bone adjacent to the
first thread of the implant near the junction of compact and cancellous bone for both
models. Since compression may compromise in vivo the periosteal blood supply29 and
lead to necrosis30, high compressive stress may increase the risk of bone loss31 and
extensive tensile stress has also been reported to cause bone resorption31,32. Similarly,
the present study revealed almost higher compressive and tensile stresses in the
conventional model than in the platform switching model at the compact bone surface
in the implant neck vicinity. But the value decreased by 41.7% for the 1st principal
stress in compression , the possible reasons may be due to the different implant design
between the connection of implant fixture and abutment, thus the direction of stress
flow would yield this difference in the stress values. As well as the locations of peak
value of 1st principal stress in compression for platform switching model (-10.3MPa)
and conventional model (-6MPa) were not the same, so they could not be comparable
(Fig 6). Apparent stress concentration was reduced in the compact bone and the stress
distribution in cancellous bone was shifted along the entire surface of the thread in the
platform switching model. It has been suggested that there is not always a linear
relationship between stress and bone failure33, platform switching design may
decrease the chance of compact bone resorption and loss of osseointegration. Further
study may be required to study the influence of increasing stress in cancellous bone.
Quek and coworkers34 showed the results of load fatigue performance and failure
location of 4 implant-abutment interface designs. Platform switching design of
Lifecore stage-1-COC abutment system (LC; Lifecore Biomedical, MN) was the only
one group without any implant fractures. It appeared that failure location was system
specific and related to the design characteristics of implant-abutment interface and
superior mechanical strength. Investigations from case-control studies have repeated
suggested that peri-implant bone changes of approximately 0.5 mm following conus
implant-abutment connection at microthreaded and titanium oxide (TiO2) grit-blasted

6
implants (Astra Tech, Waltham, MA)35-37.
Clinical observation of the bone-preserving effects of platform switching system
has been ongoing for more than a decade3,38,39. The procedure requires that the
“ switch”be in place from the day the implant is uncovered or exposed to the oral
cavity in either a one- or two-stage approach. It cannot be utilized after the
establishment of the biologic width around a conventional implant-abutment interface
configuration to regain crestal bone height15,40. It is important to note that sufficient
tissue depth (approximately 3 mm or more) must be present to accommodate an
adequate biologic width. In the absence of sufficient soft tissue, bone resorption will
likely result regardless of the implant geometry41-43.

Limitation and restriction of FE model

Material properties greatly influence the stress and strain distribution in a structure.
These properties can be modeled in FE analysis as isotropic, transversely isotropic,
orthotropic, and anisotropic. In most reported studies, the assumption is made that the
materials are homogenous and linearly isotropic. Several studies incorporated
simplified transversely isotropy instead of orthotropy into their FE models
demonstrated the significance of using anisotropy(transversely isotropy) on
bone-implant interface stresses and peri-implant principal strains18,44. It was
concluded that anisotropy increased what were already high levels of stress and strain
in the isotropic case by 20-30% in the cortical crest. In cancellous bone, anisotropy
increased what were relatively low levels of interface stress in the isotropic case by
three- to four fold45. To address the problem of incorporating more realistic
anisotropic material for bone tissues in maxilla related biomechanical studies, based
on currently available material property measurements of human mandible45-48, the FE
model of this study employs fully orthotropy for compact bone and transversely
isotropy for cancellous bone19. Because of material properties for human maxillary
bone were not available, this may influence the accuracy and applicability of the
results. However, by assigning fully orthotropic material to compact bone, the high
quality anisotropic FE model of the segmental maxilla in this study may bring us one
important step closer toward realizing realistic maxilla related simulation. To simplify
the analysis, the threads in the implant were modeled as circular rings instead of
having a spiral configuration. Additionally, 100% implant-bone interface was
established, which does not necessarily simulate clinical situations. Furthermore, the
cement layer was not modeled49,50. Thus, the inherent limitations in this study should
be considered.

When applying FE analysis to dental implants, it is important to consider not only

7
axial loads and horizontal forces (moment-causing loads) but also a combined load
(oblique occlusal force) because the latter represents more realistic occlusal directions
and, will cause the highest localized stress in compact bone50,51. A 200-N vertical and
a 40-N horizontal load were applied to the occlusal surface of the crown. Bite force
studies indicate considerable variation from one area of the mouth to another and
from one individual to the next52. These loads represent average means recorded on
patients with endosseous implants53,54. The loading condition of this study was almost
near the actual chewing force55, and the results of the maximum von Mises stress and
principal stress in the compact bone (89.2MPa-130.6MPa) would be not beyond the
bone tissue resistance56. The design of the occlusal surface of the model may
influence the stress distribution pattern. Whenever possible, flatter inclines should be
developed on cusps, and a cusp-to-fossa relationship in maximum intercuspation with
no eccentric occlusal contact should be used. In the current study, the locations for the
force application were specifically described as cusp tip, distal fossa, and mesial
fossa20. When occlusal forces exerted from the masticatory muscles, the buccal
functional cusps of the mandibular teeth will be forced to contact with central, distal,
and mesial fossa. Because a symmetric half model was used, loading locations were
applied on the central and distal fossa of the crown in this study (Fig 2).

CONCLUSIONS

Within the limitations of this study, the following conclusions can be drawn :
1. Maximum von Mises stress, compressive and tensile stresses in cortical bone were
lower in the platform switching model than in the conventional model.
2. Apparent stress distribution in cancellous bone showed not only in the palatal side
of the platform and the apical area of the implant but also along the entire surface
of the thread in the platform switching model.
3. Platform switching model was able to reduce the stress concentration in the area
of compact bone and shift it to the area of cancellous bone during oblique load.

8
FIGURE LEGENDS

Fig 1. Cross-sectional view on the symmetry plane of the meshed models. a =

conventional model; b = platform switching model.

9
Fig 2. Loading was simulated by applying an oblique load (vertical load of 100 N and

horizontal load of 20 N) from buccal to palatal at four different locations on the

central (a, b) and distal fossa (c, d) of the crown.

10
 0 3 12 22 33 45 60 75 89.2

Fig 3. von Mises stress distribution in the compact bone under oblique loading.

Maximum von Mises stress (MX) 89.2 MPa of conventional model (a) and 84.3 MPa

of platform switching model(b), respectively. MX was found adjacent to the first

11
thread of the implant near the junction of compact and cancellous bone. The white

arrow indicates more apparent stress concentration. B = buccal side, P = palatal side.

12
 Conventional Platform switching

c c

B P

b b

a a

0 3 12 22 33 45 60 75 89.2

Fig 4. von Mises stresses of each nodes are shown as a continuous line in different

three levels. a = compact bone surrounding the platform of the implant; b =

transitional area between the platform and first thread of the implant; c = junction

between compact and cancellous bone. The white arrow indicates the value of the

stress gradually increased from the buccal to the palatal side. B = buccal side, P =

palatal side.

13
0 1 4 8 13 18 23 28 33.6

Fig 5. von Mises stress distribution in the cancellous bone under oblique load.

Maximum von Mises stress (MX) 18.4 MPa of conventional model (a) and 33.6 MPa

of platform switching model(b), respectively. The white arrow indicates not only the

palatal side of the platform and the apical area of the implant but also along the entire

14
surface of the thread in the platform switching model shows the more apparent stress

concentration. B = buccal side, P = palatal side.

15
-10.4 2 16 32 50 70 90 110 131

-69.4 -58 -45 -32 -20 -8 4 16 28

Fig 6. Buccal-palatal cross-sectional view of the 1st principal stress and 3rd principal

stress in compact bone surrounding implant. The interface stress was compressive

(negative sign, white arrow) along the top half of the compact bone and tensile

16
(positive sign, red arrow) along the bottom half due to the buccal-palatal load. a = 1st

principal stress of conventional model; b = 1st principal stress of platform switching

model; c = 3rd principal stress of conventional model; d = 3rd principal stress of

platform switching model. B = buccal side, P = palatal side.

17
 3rd principal stress

2nd principal stress

1st principal stress

-100 -50 0 50 100 150

(MPa)

platform switching conventional

Fig 7. Peri-implants principal stresses (MPa) in compact bone for conventional and

platform switching models under bucco-palatal load.

18
 Material Young's modulus (MPa) Poisson's ratio References
Benzing et al.(1995)
Gold alloy 90,000 0.3
Moffa et al.(1973)
Benzing et al.(1995)
Titanium 110,000 0.35
van Rossen et al.(1990)

Table 1. Material properties of the implant and gold alloy crown.

19
 Ey Ex Ez Gyx Gyz Gxz ν
yx ν
yz ν
xz References
＊
Com 12.5 17.9 26.6 4.5 5.3 7.1 0.18 0.31 0.28 Schwartz-Dabney & Dechow (2002)
Can. 0.21 1.148 1.148 0.068 0.068 0.434 0.055 0.055 0.322 O'Mahony et al (2001)

Table 2. Anisotropy elastic coefficients for compact (Com.)and cancellous (Can.) bone＃.

＃
Ei r
epr
ese
ntsYoung’
smodul
us(
GPa
);Gij represents shear modulus (GPa); ν
ij

r
epr
ese
ntsPoi
sson’
sra
tio.

＊
Elastic coefficients for compact and cancellous bone. The y-direction is

infero-superior, the x-direction is medial-lateral, and the z-direction is

anterior-posterior.

20
 ＊
Platform switching Conventional Increase(%)
1st principal stress Maximum +98.8 +130.6 32.2
Minimum -10.3 -6 -41.7
2nd principal stress Maximum +25.1 +51.5 105.2
Minimum -15.8 -18.2 15.2
3rd principal stress Maximum +11.8 +27.9 136.4
Minimum -30.1 -69.4 130.6

Table 3. Peak values of peri-implants principal stress (MPa) in compact bone for

conventional and platform switching models under bucco-palatal load.

＊
Increase column demonstrates the increase proportion of (conventional - platform

switching)/platform switching x 100%, a negative value means the value in

conventional model decreased.

note : plus sign (+) represents tension and minus sign (-) represents compression.

21
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