Survival
of endosseous implant is highly depended on the integration between the implant
surface and the oral tissue which includes both hard and soft tissues.The first
and foremost sign of lost breakdown at the implant tissue interface is
generally seen at crestal region. Therefore, the crestal bone loss around the
implant plays a very vehicle role in determining the success of osseointegrated
implant.

The
earlier implant crestal bone loss during healing and consequently following the
first year of function is often greater during initial stage. Various studies
and literature references have demonstrated that stress concentrated around the
crestal region during/after prosthetic loading. It is observed that the density
of the alveolar bone housing may influence the early bone loss around implants.
Weber et al studies showed that low
density bone had more bone loss.

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According
to Cook et al evaluation there is a
correlation between labial plate thickness and thin or thick gingival biotypes.
Various studies demonstrated that mucosal thickness and biologic width affect
crestal bone loss around implants. It is also noticed that the dimension  and position of biological width formed
around the implant surfaces during early phase of healing may influence the
degree of implant crest module design plays a very crucial role in the
formation of biologic seal around the implant surface.

 Platform-switching is a method used to improve
the biological seal and also preserve the crestal bone level around an
implant.The concept of platform switching was introduced by Lazzara and Porter in 2006.  Lazzara et al have hypothesized that
shifting the implant-abutment junction (IAJ) inward also shifts the
inflammatory cell infiltrate inward and away from the crestal bone. Because of
horizontal inward movement of implant-abutment union thickens the connective
tissue laterally, which increases blood flow around that area. So a biological
seal establish around dental implants, these changes protect the crestal bone.

Regarding
biomechanical advantages in the use of platform switching, unlike conventional
implants where a high stress area around implant’s neck and along its lateral surface,
but in the platform switching the stress is distributed inwards towards the
central axis thus improving the distribution of forces and reduces crestal
marginal bone loss after loading.

Berglundh and Lindhe
in 1996 in their animal studies showed that a particular width thickness is
necessary required to establish biologic width around dental implant as well as
they said that if less thickness is present ,crestal bone resorption will occur
upto enough space is establish for both connective tissue and junctional
epithelium.

Formation
of the biologic width around an implant is influenced by the gingival biotype.
The gingival biotype contributes significantly to the marginal bone stability
around dentition/implant. Becker W et al
in 1997 studies shown that thin biotype associated with fenestrations and
bony dehiscences.

            According
to Wagenberg B et al and Tabata et al at
2010 the gingival biotype, the distance of the implant-abutment
junction(IAJ) from the bone crest, repositioning of the gingival inflammatory
infiltrate, and the distribution of the forces in the portion of the implant in
contact with the cortical bone  are the
factors that plays a major role in the changes of bone height.

Linkevicius studies
demonstrated that implants with thin crestal mucosa more prone to higher
marginal crestal bone loss.

In
the present study platform switched endosseous implants were placed in patients
with different gingival biotype and to evaluate hard and soft tissue changes
that occur around the dental implant over a period of one year.