## 4 Discussion  
This systematic review and meta-analysis was executed to evaluate the stability of alveolar bone loss around dental implants by comparing the radiographic MBL and implant failure rates between platform-switched implants and platform-matched implants. The purpose of this study was to assess the stability of dental implants by comparing the radiographic MBL and implant failure rates between platform-switched implants and platform-matched implants. The study's findings revealed that platform-switched implants showed a lower incidence of MBL compared to platform-matched implants. Overall, the results of this study demonstrated the usefulness of platform switching as a valuable adjunct to dental implant procedures. The technique of platform switching can be employed in various implant systems, including those that use an external hexagonal connection. The external hexagonal system is a conventional implant-abutment connection that features a hexagonal fitting on the top of the implant [24]. Implementing platform switching in an external hexagonal system entails using an abutment that is narrower than the top of the implant, which results in a  
Figure 7: Funnel plot illustrating the publication bias analysis. step-down at the implant-abutment interface. Internal implant systems, such as internal hexagonal, internal octagonal, conical (Morse taper) design, or other types of internal fitting mechanisms, are also available [25]. Internal connection systems typically provide a tighter seal at the implant-abutment interface compared to external hex systems, which can enhance mechanical stability and reduce micro-movements [26]. In internal connection systems, platform switching functions similarly by using an abutment that is narrower than the implant platform, moving the junction between the implant and the abutment inward. Studies suggest that different micro-gap configurations exhibit various patterns of bone loss during non-submerged healing, even without prosthetic loading [27]. After 10 years of follow-up, a total bone loss of 0.7 \(\pm\) 0.4 mm was measured in the equicrestal external hexagonal connection group, while a bone loss of 0.5 \(\pm\) 0.7 mm was observed in the equicrestal internal Morse taper connection group [28]. It can be inferred that an implant with a wide diameter and external hexagonal connection, restored with a platform-switching abutment, is more effective in reducing bone loss compared to the platform-matching abutment [29]. The concept of platform switching focuses on strategically moving the inflammatory cell layer away from the crucial bone interface to prevent crestal bone loss, a prevalent issue near implants. This mechanism was investigated in a study that assessed the distribution and density of inflammatory cells around implants with supracrestal, crestal, or subcrestal implant-abutment interfaces [28]. The results demonstrated a consistent pattern of peri-implant inflammation across all groups, characterized by a peak accumulation of neutrophic polymorphonuclear leukocytes (neutrophils) at or directly coronal to the interface [30]. Platform switching is distinguished by specific features in the implant-abutment connection designed to effectively manage bacterial proliferation [3]. A comparative analysis revealed that platform-matched implants placed at the crestal level exhibited a significantly higher mean bacterial load in the peri-implant sulcus fluid compared to those with platform switching [7]. These observations emphasize the potential of platform switching to improve peri-implant health by reducing the inflammatory burden and bacterial presence at critical tissue interfaces. The use of platform-switched implants has been demonstrated to facilitate lower stress levels within the peri-implant bone, resulting in a more uniform distribution of stress [31].