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 2
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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
Healing response is sometimes not compromised
by disease but medication.
One very common type of medication
that can interfere with implant therapy
is the so-called antiresorptive drugs,
a group of pharmaceuticals that have been developed
to counter the effects of osteoporosis and osteopenia.
The most common and best studied drugs
in this group are the bisphosphonates.
These drugs have been initially used
for the treatment of cancer,
but they're widely prescribed to patients
with osteoporosis as they can prevent bone resorption
and increase bone density.
The use of bisphosphonates has been correlated
with an osteonecrosis of the jaw,
especially in conjunction with invasive procedures
such as extraction or minor oral surgery.
In cases of patients under bisphosphonates,
we need to identify three factors
to support our decision making.
First, why do patients receive bisphosphonates?
Second, which drug do they take
and what is the delivery mode?
And third, how long have they been under the medication?
Today, any patient receiving oral bisphosphonates
for the treatment of osteoporosis
for five years or less should be considered safe
for implant placement.
Intravenous delivery of bisphosphonates
for the treatment of osteoporosis is gaining popularity.
In these cases, the tablets are replaced
by one annual intravenous infusion.
There is little evidence to suggest increased risk
in such cases and caution needs to be exercised
evaluating the amount of years the patient
has been under treatment.
Finally, intravenous delivery of bisphosphonates
for the treatment of cancer is increasing significantly
the doses and the risk for osteonecrosis
and in such cases implant surgery
should be completely avoided.
A newer drug with increasing popularity is Denosumab,
which is a monoclonal antibody.
This is a relatively new drug
and although it was initially introduced
as a safer alternative to bisphosphonates,
it appears it is also increasing the risk for osteonecrosis.
As this is a new drug
and we have little evidence of its potential risks,
extreme caution should be exercised
prior to deciding implant therapy for such patients.
Furthermore, we have certain conditions
that might be compatible with health,
but they indicate susceptibility
and consequently an increased risk for failures.
A typical example of such a condition
is the history of periodontitis, describing patients
who have been in the past diagnosed with periodontitis,
even if they currently enjoy good gingival health.
Several studies have shown
that such patients are significantly more likely
to develop peri-implant disease as well.
However, this does not mean that such patients
should be excluded from dental implants.
History of periodontitis is an indicator
of susceptibility of the patient
to periodontal and peri-implant inflammations.
With a good level of oral hygiene
and a regular maintenance scheme,
such patients can also enjoy highly successful
and sustainable treatment outcomes.
So history of periodontitis is not a contraindication,
but it is a warning signal.
Other conditions where implants should be avoided
is cases of young individuals
with residual skeletal growth
or patients with limited compliance.
Remember, despite significant progress,
we are still far away from providing
a treatment suitable for every patient with missing teeth.
Implants remain a high maintenance device
and require a significant lifetime commitment
from the side of the patient.
Careful patient selection and risk assessment
remains the cornerstone of success.
