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。
系统性的评估风险 1
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来自 The University of Hong Kong 的课程
口腔种植学 （Implant Dentistry）
27 个评分
从本节课中
种植牙和患者
患者选择和治疗计划是种植牙成功的基石。本模块中，我们将评估所有系统性，解剖学和行为上的风险，并帮助你设计综合治疗计划中的所有步骤，以满足患者的实际需求。
与讲师见面
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Today, I would like to start with a historical picture.
Take a close look at the person in the photo.
Notice that she has a closed breathing circuit,
so that not even the air she breathes will escape
in the environment.
You might think that the photo is from a deadly virus outbreak
or a space movie.
Today, it might be hard to believe that the person
in the astronaut suit was actually a dental surgeon
on her way to perform an implant surgery in the late 70s.
After 40 years of research, implant dentistry
has come a long way since that pioneering times.
The indications for implant placements have expanded
and more than 10 million dental implants
are placed worldwide every year.
Does this mean that implants are for every one
with missing teeth?
Certainly not!
Despite the significant progress,
not everyone is suited for dental implants
and careful patient selection
remains still the most important factor to ensure long term success.
From a systemic point of view,
we identify two types of contraindications for dental implants:
the absolute and the relative.
As you guessed, the absolute contraindications are few.
The relative, however, are the tricky situations
where the evidence is not conclusive
and our clinical judgement needs to be well supported
by the current best practices and guidelines.
Let's take a look at the main contraindications
for implant therapy as based on
the currently available evidence.
Highest in the list is: plaque and periodontal inflammation.
Today, we know well that bacterial plaque is the No. 1 enemy
for the long term survival of dental implants.
If bacterial plaque is left to accumulate
on dental implants, inflammation of the peri-implant tissues
in the form of Peri-implant mucositis
or peri-implantitis is the expected tissue response.
Peri-implantitis is a condition that is difficult to manage.
And as we will see in one of the next modules,
it can pose a serious threat to
the survival of dental implants.
Consequently, if your patient is not able to practice
effective oral hygiene, or if he has an active periodontal disease,
do not proceed with dental implants.
The next group is the modifying factors,
factors which would not cause implant failure directly
but they can modify our body's immune response,
amplify the effects of inflammation,
compromise the healing ability of the body,
and increase the risk for failures
either in short or long term.
Diabetes mellitus is among the most well-studied
modifying factors.
Diabetes is a metabolic disorder which is defined
by patient's inability to maintain
a stable blood sugar level.
In reality, however, diabetes can include
a wide array of pathological conditions
and such patients appear to be more susceptible
to periodontal and peri-implant inflammations
while they might also present
with compromised wound healing.
The metabolic control is the key for decision making
in such patients.
And this is expressed by the value of
glycated hemoglobin (A1C), which should be less than 7%
in order to consider the patient in “tight control”.
A patient under “tight control” is a good candidate
for implant placement, while a value bigger than 7%
will indicate that improvement of the metabolic control
is required before we proceed with implant placement.
Similarly, a lot of research has documented
the detrimental impact of smoking
for the longevity of dental implants.
Smokers get a higher risk of peri-implant inflammations,
compromised healing ability, and lower success rates
in the medium and long term.
Again, the effect appears dose related.
Heavy smoking increases the risk for both early failures,
as well as, long term complications.
Although it does not constitute an absolute contraindication,
every patient should be offered
smoking cessation support and advice to quit or reduce smoking
before implant placement.
If smoking persists, the patient must be made aware
of the increased risks
and strict maintenance must be exercised.
