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The honest truth about platform switching, implant biology? Most courses skip the hard parts. I wrote this so you don't ...
23/04/2026

The honest truth about platform switching, implant biology? Most courses skip the hard parts. I wrote this so you don't have to learn the painful way I did. https://periospot.com/blog/the-story-behind-platform-switching

What does platform switching means and what are the benefits that this concept brings from a clinical and patient's point of view.

23/04/2026

The Disease That Ate Their Gums

Lisbon. July 8, 1497. Vasco da Gama sails with 170 men. 116 never come home.
The killer? Not storms. Not pirates. Scurvy.
Their gums swelled, turned purple, bled. Their teeth loosened and fell out. Old wounds reopened. The logbook says their gums "grew over their teeth so much they could not eat."
The mechanism: without vitamin C, collagen synthesis stops. The periodontal ligament dissolves. Teeth lose their anchor.
At Mombasa, oranges saved the survivors. But the cure was forgotten. Found again by Lind in 1747, ignored for 48 years. In 1776, a Dutch surgeon scraped seaweed off his ship's hull and cured his patients with it.
2 million sailors died over 3 centuries from a periodontal disease that could have been cured with an orange.
The mouth tells the story of the whole body. It always has.
Full story on periospot.com

23/04/2026

Osseointegration: The Dynamic Healing Process

Osseointegration is not magic.
It is biology.

An implant can be placed in minutes, but true integration happens through a staged healing process that starts with primary stability and evolves into biological stability over time.

This is the part many people never see:
the interface changes, woven bone forms, remodeling happens, and the implant gradually becomes part of a functional system.

That is why implant success is never just about placing titanium.
It is about respecting biology.

Would you like me to create a second animation comparing primary stability vs final osseointegration?



Instagram caption, shorter and punchier

An implant is placed in minutes.
Osseointegration is earned over time.

This animation shows the biological sequence that turns primary stability into true functional integration.

Titanium starts the process.
Biology decides the outcome.

22/04/2026

The Shape That Controls Your Gingiva

The shape you can't see controls everything you can. A 2025 RCT: convex emergence = 13x more recession. Three zones. One principle. Shape your abutment, shape your result.
Huge credit to the researchers who defined these concepts:

Based on Su, Gonzalez-Martin et al. 2010 (IJPRD) and Gomez-Meda, Esquivel & Blatz 2021 (JERD). New 3-year RCT data from Endres et al. 2025 (JCP).

In 2010, Su and Gonzalez-Martin defined two zones that control peri-implant soft tissue: the critical contour and subcritical contour. In 2021, Gomez-Meda, Esquivel and Blatz expanded this into the Esthetic Biological Contour (EBC) concept with three zones: E (esthetic), B (bounded), and C (crestal).
A 2025 RCT (Endres et al.) confirmed what they predicted: convex emergence profiles are 13x more likely to cause recession than concave profiles.
The shape you design under the gingiva determines the result you see above it.
References:

Su H, Gonzalez-Martin O, Weisgold A, Lee E. Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int J Periodontics Restorative Dent. 2010;30:335-343.
Gomez-Meda R, Esquivel J, Blatz MB. The esthetic biological contour concept for implant restoration emergence profile design. J Esthet Restor Dent. 2021;1-12.
Endres K, et al. Convex versus concave emergence profile of implant-supported crowns in the aesthetic zone: 3-year results of a randomized controlled trial. J Clin Periodontol. 2025.
Siegenthaler M, et al. Anterior implant restorations with a convex emergence profile increase the frequency of recession: 12-month results of a RCT. J Clin Periodontol. 2022;49:1240-1251.

22/04/2026

How deep should you place your implant? 🦷

The Pareto Principle says 20% of the implant bears 80% of the stress. So where you position that critical zone relative to bone changes everything.

Three philosophies:

🟢 Supracrestal — gap ABOVE bone, bacteria can't reach. Lowest peri-implantitis rates. Gold standard.

🟡 Equicrestal — gap AT bone level. That "normal" 1.5mm bone loss? It was never normal. It was bacteria at the wrong depth + thin tissue.

🔵 Subcrestal — gap BELOW bone. Works beautifully with Morse cone (zero leakage, bone grows OVER the shoulder). Catastrophic with external hex (bacteria pump into bone).

The rules:
✅ Morse cone only for subcrestal
✅ One abutment, one time — never disconnect
✅ ISQ

Smoking does not guarantee implant failure. It bends every odd in the wrong direction. Across meta-analyses from 2020 to...
22/04/2026

Smoking does not guarantee implant failure. It bends every odd in the wrong direction.

Across meta-analyses from 2020 to 2025, smoking keeps surfacing as one of the most consistent modifiable risk factors in implant dentistry. The signal is steady. The direction is always the same.

The number to remember: smokers carry roughly 2.4 times the odds of implant failure compared with non-smokers, pooled across implant systems and follow-up periods (Mustapha et al., 2022). Same surgery, different bone. In the same analysis, smokers showed on average 0.58 mm of additional marginal bone loss around the implant. Small number, compounding outcome.

The timeline (first platelet plug, soft tissue seal, bone remodeling, loading readiness) is the general osseointegration scaffold described by Berglundh et al. (2003) and Bosshardt, Chappuis, and Buser (2017). The smoking effects along that scaffold are mapped by mechanism rather than by validated timepoint, and slide 6 flags that honestly.

What the clinician actually does:
Assess ci******es per day before planning. Counsel and offer cessation support as part of informed consent. Plan individualised loading and stricter maintenance. Monitor marginal bone year by year. That is the 2023 EFP S3 prevention framework translated into a workflow (Herrera et al., 2023).

What the evidence does NOT say:
1. Smokers cannot receive implants. An absolute refusal is not evidence based.
2. Cessation is an instant biological reset. Stopping is right, but the peri-implant recovery curve is still poorly quantified.
3. Va**ng is proven safe. Nicotine-containing e-ci******es show worse peri-implant parameters in some studies, but the evidence base is newer and less mature than for ci******es.


Contribution to related research to the topic:

herreragarcia



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