口腔种植学是口腔教育中较新的学科。虽然现在我们都有共识，种植⽛相关的理论知识，⽆论是治疗⽅案的规划，还是后期的随访和维护，对于每⼀个职业⽛医都⾮常重要。然⽽，在当下全球的口腔医学本科培养体系中，它的覆盖程度还远远落后于其重要性。 在此背景下，香港大学口腔医学院联合⾹港⼤学的线上教育专业团队，历时⼀年有余，设计并制作了这门为期五周的⽹络公开课，旨在传播以循证医学为基础的，客观、全⾯的⽛种植学相关知识。这门课程⾯向全球，双语教学，完全免费。学员将在20 多位全球领先的种植学专家的带领下，完成五个模块，系统地学习⽛种植学。
种植体的选择
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来自 The University of Hong Kong 的课程
口腔种植学 （Implant Dentistry）
30 个评分
从本节课中
种植牙，生物学基础，技术工艺
什么是种植学？这一学科如何开始，又是经历了什么重大突破发展到现在的阶段？什么样的种植体更有益于我们的患者？本模块中，我们将回顾骨结合背后的基本生物学概念，以及其对临床决策的影响。
与讲师见面
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Hi colleagues, welcome to this short lecture. 各位同事，欢迎来到这个简短的讲座。
I'm happy to discuss with you implant selection. 我很高兴和你们一起讨论有关种植体选择的话题。
In the first slide you see a large number of implants, 第一张幻灯上你看到有很多种植体，
and when we want to choose implants 当我们要选择种植体时
we have a number of decisions we need to make. 我们需要做很多判断。
So clinically from this large palate, 从临床角度
the question is which implant type should I use 回答这个问题，哪一种种植体应该使用在
in which clinical situation? 哪一种情形呢？
Let’s go in to some basics first. 我们先来看一些基本的。
On the right side, you see a so called two-piece implant 右边你看到的是两段式种植体，
which consists of the endosseous part of the implant. 只有骨内段部分。
At the left side you see a one-piece implant, 左侧你看到的是一段式种植体，
you see that the transmucosal part is integrated 你可以看到穿龈部分和
into the entire implant so the endosseous 骨内段变成一个整体。
and the transmucosal part make up the implant itself. 也就是这个种植体包含骨内段和穿龈段两部分。
What does this mean? 这意味着什么呢？
Here you see the bone level, 这里你可以看到骨水平，
the two-piece implant stops at the level of the bone 两段式种植体以骨水平为基准
and the one-piece implant reaches through the soft tissues 而一段式种植体可以穿过软组织，
to a level where we can see in the oral cavity. 我们在口内能直接观察到。
I also indicate a reconstructive margin 这里我用蓝线标记出
with these blue lines. 修复边缘。
Reconstructive margin at the two-piece implant 两段式修复体的修复边缘
is at the level of the bone where as 与骨水平一致，
at the one-piece implant, 而一段式种植体的修复边缘
it's 1mm, 2mm, or 3mm distant from the bone. 大约在骨水平以上1mm,2mm,或3mm处。
What does this now mean for clinical use? 这在临床上意味着什么呢？
Two more important words we need to define. 这里有几个重要的名词我们需要解释一下。
You see an implant on the left side 左边你可以看到种植体
and you see the flap close at the right side, 而右侧你只能看到术创，
and here the flap is sutured to cover the implant completely, 这里因为软组织瓣缝合后完全覆盖了种植体。
this is termed submerged healing, 这叫做埋入式愈合(submerged healing)。
so the implant is submerged underneath the soft tissues. 也就是种植体在软组织下方。
Here the flap is sutured 这里种植体可以穿过
allowing the implant to penetrate into the oral cavity. 缝合的软组织直达口内。
You see the flap raised on the left side 左侧你看到翻瓣，
and you see the flap adapted around the neck 右侧你看到软组织瓣
of the implant on the right side, 顺应着种植体颈部。
this is called transmucosal healing. 这叫做穿龈式愈合(transmucosal healing)。
Submerged healing is preferred 埋入式愈合
when soft tissue borne temporaries are used. 通常用于软组织要支持临时修复体时。
Here, two-piece implants are preferred. 这种情形倾向于使用两段式种植体。
The reason being, it's easier to cover the implants 原因是，这样较容易用
with the soft tissues, 软组织覆盖种植体。
and thus avoiding a removable temporary to transfer forces exerted onto the temporary
避免了可摘临时修复体将
onto the heads of the implant, 力量传递给种植体，
and thus prevent osseointegration from occurring. 这种力量会阻碍骨结合。
Additionally submerged implant is preferred 此外，埋入式愈合倾向于使用在
when later soft tissue interventions are planned. 后期计划进行软组织移植的位点。
Here again two-piece implants are preferred 还有，通常对美学要求较高的位点，
in situations which are usually for aesthetic nature. 倾向于使用两段式种植体。
Two-piece implants are preferred in the esthetic zone 美学区倾向于使用两段式种植体
because they allow more flexibility 原因是因为它们允许更大的灵活性
for shaping the emergence profile. 可以用来塑造穿龈形态。
Here you see a two-piece implant on the left 这里左边你可以看到一个两段式种植体
and a one-piece implant on the right side, 右边是一段式种植体。
and marked again, the reconstructive margin. 同样在修复体边缘处做了标记。
Now we see the distance from the reconstructive margin 现在我们分别看看左右两边，修复体边缘
to the soft tissue margin on the left and the right side, 距离软组织边缘的距离。
and you immediately see that with the two-piece implant 你可以明显发现两段式种植体
there's a larger distance available 距离更大
which allows more flexibility. 这样允许更大程度上的灵活度。
Let me illustrate this with the image on the left, 我来用左边这张图解释一下，
you see an implant in site two, 你可以看到21位点有一颗种植体，
the yellow circle indicates the top end of the implant, 黄色圆圈表示种植体顶部，
these dotted lines indicate the form of the tooth 虚线表示要修复的
which needs to be reconstructed, 牙冠的轮廓。
which of course is identical to the tooth adjacent to it. 这个当然要参照临牙的形态。
You can also transfer these two dotted lines 你也可以将这两条虚线转移到
on the right side of the image. 右边这张图片上。
If I now soon propose an implant, 假如我要在这里植入种植体，
you will see that the white lines 你看到白色边
indicate the distance available to form 至冠边缘的距离，表明可利用的
this so called emergence profile. 穿龈形态。
So here two-piece implants are preferred. 这里就更推荐使用两段式种植体。
They allow more possibilities for soft tissue management, 它为软组织成形提供更多的可能性，
increase the prosthetic flexibility. 也增加了修复设计的灵活性。
On the other hand one-piece implants 另外一方面，一段式种植体
are indicated for transmucosal healing 使用在需要穿龈愈合的情形，
when straightforward procedures are preferred. 通常是希望简化手术操作。
Here you see a mandibular posterior area, 这里你看到下颌后牙区，
flap is raised, an implant is placed, 翻瓣后，植入种植体。
and the flap was adapted around the neck of the implant. 软组织顺应种植体颈部形态愈合。
What about implant length? 那么关于种植体长度又如何选择呢？
Very obvious, short implants are placed 显然，短种植体用于
when the bone height is of low height. 骨高度不足时。
As you can see on the right side 正如你看到右边的影像学图片，
the radiographic image, on the left side the clinical image. 左边是临床照片。
What about implant diameters? 种植体的直径又有什么影响呢？
There are some implants that are allow smaller diameters 现在有很多系统提供直径比
than standard implants. 标准更小的种植体。
Narrow implants are placed in narrow spaces, very obvious. 显然，窄径种植体的好处是在间隙较狭窄的地方。
I have so proposed the X-ray, 给大家看这张X光片，
so you see two narrow implants 你看到两个窄径种植体
with narrow reconstructions for lower incisors. 支撑两个很窄的修复体，以恢复缺失的下颌切牙。
What about cylindrical versus tapered implants? 那么圆柱形和锥形的种植体有什么区别？
A cylindrical implant on the left, 左边是圆柱体形态的种植体，
a tapered implant on the right. 右边是锥体形态的。
The rationale for choosing tapered implants 使用锥体形态种植体
or choosing this design is that they usually have 通常是因为
denser thread distribution, the threads reach closer 这些植体的螺纹分布更密集，
to the apex, they are more congruent with the bony bed, 螺纹可以深达种植体尖端，与种植体窝形态更一致，
and thus all these factors together 这些特点
improve primary stability. 提高了种植体初期稳定性。
So tapered implants are placed into extraction sockets 因此，锥体形态的种植体常常使用在
because they show improved contact 新鲜的拔牙窝，因为它们显示出
in the bony walls of the alveolus. 与骨壁更好的接触效果。
This is true in anterior, as well as, posterior sides. 这在前牙区是真实可行的，同样，后牙区也适用。
Let me conclude what we've seen 那么我来总结一下，
regarding implant selection. 有关种植体选择的问题。
Two-piece implants are used for submerged healing, 两段式种植体用于埋入式愈合。
they're used to improve soft tissue management, 它可以为软组织成形提供更大的空间，
and they are used to improve the prosthetic flexibility. 增加了修复设计的灵活性。
One-piece implants in contrast are used 一段式种植体，相反，
for transmucosal healing, and they are used 是穿龈式愈合，
to simplify prosthetic protocols 适用于想要简化修复方案时。
because the implant shoulder is located close 因为种植体肩台位于
to the mucosal margin. 靠近黏膜边缘的位置。
Conical implants improve primary stability 锥体形态的种植体可以提高初期稳定性，
due to the thread design and implant form. 这是因为螺纹的设计和种植体形态。
Diameter reduced implants at sites with reduced gaps 减径种植体用于间隙较窄的病例，
and for minimally invasive surgery. 也体现了微创手术的理念。
Thank you very much for your kind attention. 谢谢你们的关注。
