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）
22 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
Dear colleagues, welcome to this short lecture.
I'm happy to discuss with you implant selection.
In the first slide you see a large number of implants,
and when we want to choose implants
we have a number of decisions we need to make.
So clinically from this large palate,
the question is which implant type should I use
in which clinical situation?
Let’s go in to some basics first.
On the right side, you see a so called two-piece implant
which consists of the endosseous part of the implant.
At the left side you see a one-piece implant,
you see that the transmucosal part is integrated
into the entire implant so the endosseous
and the transmucosal part make up the implant itself.
What does this mean?
Here you see the bone level,
the two-piece implant stops at the level of the bone
and the one-piece implant reaches through the soft tissues
to a level where we can see in the oral cavity.
I also indicate a reconstructive margin
with these blue lines.
Reconstructive margin at the two-piece implant
is at the level of the bone where as
at the one-piece implant,
it's 1mm, 2mm, or 3mm distant from the bone.
What does this now mean for clinical use?
Two more important words we need to define.
You see an implant on the left side
and you see the flap close at the right side,
and here the flap is sutured to cover the implant completely,
this is termed submerged healing,
so the implant is submerged underneath the soft tissues.
Here the flap is sutured
allowing the implant to penetrate into the oral cavity.
You see the flap raised on the left side
and you see the flap adapted around the neck
of the implant on the right side,
this is called transmucosal healing.
Submerged healing is preferred
when soft tissue borne temporaries are used.
Here, two-piece implants are preferred.
The reason being, it's easier to cover the implants
with the soft tissues,
and thus avoiding a removable temporary to transfer forces exerted onto the temporary
onto the heads of the implant,
and thus prevent osseointegration from occurring.
Additionally submerged implant is preferred
when later soft tissue interventions are planned.
Here again two-piece implants are preferred
in situations which are usually for esthetic nature.
Two-piece implants are preferred in the esthetic zone
because they allow more flexibility
for shaping the emergence profile.
Here you see a two-piece implant on the left
and a one-piece implant on the right side,
and marked again, the reconstructive margin.
Now we see the distance from the reconstructive margin
to the soft tissue margin on the left and the right side,
and you immediately see that with the two-piece implant
there's a larger distance available
which allows more flexibility.
Let me illustrate this with the image on the left,
you see an implant in site two,
the yellow circle indicates the top end of the implant,
these dotted lines indicate the form of the tooth
which needs to be reconstructed,
which of course is identical to the tooth adjacent to it.
You can also transfer these two dotted lines
on the right side of the image.
If I now soon propose an implant,
you will see that the yellow lines
indicate the distance available to form
this so called emergence profile.
So here two-piece implants are preferred.
They allow more possibilities for soft tissue management,
increase the prosthetic flexibility.
On the other hand one-piece implants
are indicated for transmucosal healing
when straightforward procedures are preferred.
Here you see a mandibular posterior area,
flap is raised, an implant is placed,
and the flap was adapted around the neck of the implant.
What about implant length?
Very obvious, short implants are placed
when the bone height is of low height.
As you can see on the right side
the radiographic image, on the left side the clinical image.
What about implant diameters?
There are some implants that are allow smaller diameters
than standard implants.
Narrow implants are placed in narrow spaces, very obvious.
I have so proposed the X-ray,
so you see two narrow implants
with narrow reconstructions for lower incisors.
What about cylindrical versus tapered implants?
A cylindrical implant on the left,
a tapered implant on the right.
The rationale for choosing tapered implants
or choosing this design is that they usually have
denser thread distribution, the threads reach closer
to the apex, they are more congruent with the bony bed,
and thus all these factors together
improve primary stability.
So tapered implants are placed into extraction sockets
because they show improved contact
in the bony walls of the alveolus.
This is true in anterior, as well as, posterior sides.
Let me conclude what we've seen
regarding implant selection.
Two-piece implants are used for submerged healing,
they're used to improve soft tissue management,
and they are used to improve the prosthetic flexibility.
One-piece implants in contrast are used
for transmucosal healing, and they are used
to simplify prosthetic protocols
because the implant shoulder is located close
to the mucosal margin.
Conical implants improve primary stability
due to the thread design and implant form.
Diameter reduced implants at sites with reduced gaps
and for minimally invasive surgery.
Thank you very much for your kind attention.
