选择恰当的种植时机和方案

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En provenance du cours de The University of Hong Kong

口腔种植学（Implant Dentistry）

28 notes

The University of Hong Kong

口腔种植学（Implant Dentistry）

28 notes

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。

À partir de la leçon

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。

选择恰当的种植时机和方案7:14

引导性组织再生的生物学原则10:18

前牙美学区的引导骨再生方案7:37

牙种植手术中的自体骨移植技术 (*新增内容)7:52

上后牙区种植牙 (*新增内容)5:42

上颌窦内提 (*新增内容)5:50

上颌窦外提 (*新增内容)3:14

Rencontrer les enseignants

Nikos Mattheos
Clinical 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.

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