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。
第三周总结
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From the course by The University of Hong Kong
口腔种植学 （Implant Dentistry）
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From the lesson
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。
Meet the Instructors
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Dear friends, we're slowly coming to the end
of Week 3 in our course.
This week, the discussions focused around
the surgical placement of dental implants
and in particular, much of our interactions were about
minimally invasive implant dentistry.
And as many of you noted and discussed on the forum,
implant dentistry minimally invasive is not something
that we can achieve at a certain point in time.
But rather, it is a continuous effort,
a continuous strive to use the understanding we have
and the knowledge of the biology and the tissues
together with the potential offered to us by the technology
in order to achieve successful outcomes
with less and less invasive procedures,
less and less tissue damage,
less and less treatment time.
When it comes to technology,
certain technological developments in the last few decades
have contributed to us today being able to provide
complex treatments with less and less trauma,
less and less invasive procedures.
If I was to single out some of these development,
the major improvements in the implant surfaces,
together with strengthening of the implant alloys,
and also the improved design of the implants in itself
have contributed to allow us to use smaller
and thinner implants today,
to get increased primary stability in size, I think in the past
we would need to go through complex augmentations
to achieve the same outcomes with reduced tissue damage,
improved healing and satisfy the principles of striving
for achieving our successful outcomes
with less exposure of the tissues,
with less trauma,
with less surgical time and treatment time in total.
Much of the rest of the discussions
evolved around risk assessing our current patients
and trying to classify somehow the complexity
of the procedures that we would have to deal with
in order to offer them the treatment they required.
And a good advice for a place that will help you
to evaluate all of the factors that can contribute
to the complexity of implant procedures
is the SAC Classification
by the International Team of Implantology.
You will find the required link for the online assessment tool
into your readings in this module.
This tool is free and online
and it will allow you to put in a good sequence,
and a good order, all the possible factors
that contribute to the complexity of the case
and then make a well-informed decision
as to how complex the case can be,
if this case would be something for a novice
or a more experienced clinician
and what are the related risks.
Going through the discussions,
I think most of us agreed that after we have been
through the systemic assessment,
the actual procedures related to the treatment of Mary
are more or less straightforward.
Justin, on the other hand,
comes with a much more complex situation.
Justin is a young guy and he's quite focused on aesthetics
and maybe this is why many of you considered
an immediate implant with an immediate temporary crown
as a very good solution for his case.
And I would agree that actually a patient like Justin
would very much appreciate the immediate aesthetics offered
by such a solution.
One has to also be very mindful of the risks
and especially the critical importance of the local anatomy
for the success of immediate implants of that type.
Once the tooth is removed,
the immediate implant will not replace
the position of the root.
We indeed have to place the implant
in a slightly different position,
usually deeper into a more palatal direction
and that makes the bone margins on the mesial, distal
and buccal side quite critical for the predictable outcomes.
We will then have to use some augmentation material
to fill in the space between the implant
and the buccal wall of the socket
and cover everything with our temporary abutment
and the temporary crown.
Justin, at the same time,
had some active periodontal inflammation
on the distal side of the tooth
which was corresponding to the fracture.
Now there was significant bone loss on the distal side
and that has made the bone margins quite uneven.
At the same time,
Justin had lost quite a big amount of bone
on the buccal wall as well
and that would make any type of augmentation of this place
together with an immediate implant
rather risky and unpredictable.
Therefore, we opted to go for a safer pathway in this case
and that is to extract the tooth,
let the socket heal and come for an early placement.
In Gina's case, we could see the importance of
restorative-driven implant placement.
As you could see,
the operator used a surgical template
which would resemble the margins of the ideal crown
and he would use this as a guide in order to ensure
that the implant was placed
in the perfect prosthetic position.
As you can see in this cut from the video of the procedure,
the actual buccal margin of the crown is what will guide us
in order to define the depth of placement of the implant.
In this case,
the bone was actually much higher than necessary.
As we discussed in Module 1,
we need at least 3 mm of space
to achieve the correct soft tissue attachment
around our implant or the abutment
and if the bone is too high, then we had to generate this.
And this is why you notice
that in this particular procedure,
the operator had to remove slightly some of the marginal bone
of the alveolar ridge in order to achieve
the optimum prosthetic placement and aesthetic outcomes.
And with that, I think we have already completed
much to know and much discussion with regards to the
surgical placement of implants and how this corresponds
to all the previous phases of assessment and planning.
With that, I wish you a happy and nice weekend
and I'm looking forward to see you again next week online
when we will discuss the aspects
of restoration of dental implants.
Thank you very much.
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