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。
选择恰当的种植时机和方案
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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
种植牙手术
第3模块的课程将关注种植体的植入。我们将讨论植入方案，以及常见的重要临床决定，例如种植体植入的时间等。我们还将探讨在后期手术治疗期间的预期，包括并发症和风险。除了理论知识，本模块还包含一系列临床应用视频，详细介绍手术设置，手术技术，植入步骤和缝合技术等。
与讲师见面
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Welcome to the discussion on immediate implants.
When we have to deal with a lost tooth in the front region,
that normally asks us to place an implant
rather than a conventional bridge,
because with a conventional bridge
we would have to cut preparations in the neighbouring teeth.
So the most biological way of replacing
a missed single tooth is going to be the implant.
Now, if you want to do that
then you want an illusion close to nature
that you create with your treatment
with implant placement and subsequently,
an appropriate prosthetic reconstruction.
In doing that, there is no shooting from the hip,
no show business.
You have to follow the rules of biology.
It is a difficult procedure predominantly
in the area of aesthetic priority.
While it is not so difficult to do
with following a few rules,
you have here an example
where the implant was placed into the extraction socket
and then you have six months later,
everything in blue shows you
addition of bone structures
so it heals nicely into the alveolar socket.
And we're also happy about the appearance
even though here we can criticize
that we have somehow the implant shining through.
But it basically looks at this single tooth replacement
as an illusion close to nature.
Unfortunately this doesn't always stay like that
and that is the warning sign I may use here
because let's say two years later,
we have appearances like that.
Obviously this is unacceptable today
from an aesthetic point of view.
Now, why does this happen?
Is this because we do something wrong
or what is the reason for that?
Well, we have realized that immediate implant placing
has risks and disadvantages.
The implant bed preparation is difficult,
the bone augmentation procedures are normally needed
and primary soft tissue closure is difficult to obtain.
If I want to augment the contours at the same time,
I probably don't have enough soft tissue to cover.
And this is problematic also in infected sites.
Increased risks for facial bone resorption
and consequent soft tissue recession
are the big risks for immediate implant placement.
We have done a systematic review to extrapolate
and find out how much that change
in the dimensions of the alveolar process
is happening within humans.
We conclude that in the hard tissues,
the horizontal resorption that was much more than
the vertical resorption,
that is about 29 to 63% much more than what I just show
for the vertical resorption at six months.
The linear changes vertically are 1 to 1.3 mm
but horizontally, the same resorption
is about 3.8 mm,
showing you how the buccal bone is melting away.
The soft tissue changes only.
There are linear changes there as well.
I want to finish up this presentation
by showing you a study on immediate implants
placed into the extraction socket.
Some of the implants were cylindrical
and others were filling in the alveolus a little bit better
having a tapered design.
This is a 3-centre study that was done in Berne
and in Madrid and in Panama.
We have 120 patients,
60 for the test group and 60 for the control group.
The test group being the tapered implant
and the control group being the parallel design implant.
Now, this study was supposed to last three years.
Now, here you have such a reopening after four months
and you see that all of a sudden
the gaps that were present in the extraction sockets
have disappeared, they are filled up.
Overall, most of the gap was filled with bone
without the need of any grafting material.
And we had significantly greater gap fill
with the cylindrical implants,
not with the conical ones.
There was a significant reduction
in the buccal crest contour of about 33%
and that was more pronounced in the anterior region
when there were thin buccal bony crests
when the patient had a history of periodontitis.
The factors for instance to consider
is the thickness of the bony plate, the buccal plate,
the horizontal position of the implants,
as I said preferably 2 mm
towards the palatal.
The vertical position of the implant,
as I said 1 mm into the socket.
Apical to the crest and finally, smoking habits.
They should be a non-smoker
and the patient should not have had
any history of periodontitis.
These are all the factors
that influence the esthetic outcome.
And in summary, you can see
that this is quite difficult to achieve.
We should choose a conservative approach,
keeping all the tissues
and since an extraction leaves an open space,
we should have this first filled with soft tissue healing.
So, we do generally only type 2 placements today
and use a very standardized protocol in our treatment.
Give the tissues time to heal.
Not everything has to be immediate, immediate, immediate
because the failure may also follow immediate.
To create the perfect illusion,
use a very strict protocol
and observe the factors that influence this healing.
Thank you very much for your attention.
