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。
第四周 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
种植牙的修复
在第四模块，我们将回顾种植体修复的主要途径和选择：单冠，固定桥或义齿。我们将讨论重要的临床选择：螺丝固位还是粘结固位，种植水平还是基台水平。我们还将研究临床应用的具体，学习种植体的取模技术，准备临时修复，以及如何利用这些技巧，达到最佳的美学效果。
Meet the Instructors
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Dear friends, thank you for staying with us
during Module 4 of our course!
This week was a very important week
and it is the time when all the pieces
of the puzzle start to fall in place.
Once you master the principles
of implant prosthodontics and rehabilitation,
it is then when everything else makes more sense,
from diagnosis to patient selection,
and the planning of surgeries.
As before, we had many interesting
discussions this week as well.
Much of the discussions evolved around
the topics of prosthesis retention
and different types of cement retention
or screw retention were proposed for our patients.
As you have realized by now,
there is not absolute right or wrong in this case.
The angle of the implant placement
is a critical determinant for whether
we will be able to use screw retention or not.
Nevertheless, in many cases we actually
have the option to use both screw retained
or cemented reconstructions.
In these cases, the selection should be done
on an individual basis and there are many factors
that we have to take in consideration,
such as retrievability of the prosthesis,
the available prosthetic space and its characteristics,
the ideal emergence profile,
aesthetic needs of the patient,
and also cost related factors.
As some people also discussed,
the dilemma between screw retained
or cemented prosthesis is not always absolute.
At times, we can also use unconventional
technological solutions which allow screw retained crowns
to be placed even on implants
with unfavourable angles of placement.
An example of such a solution at the abutment level
is the angled screw channel,
where a modification of the abutment screw
and the screwdriver allows us to place the crown
on the implant with an angle as much as 25 degrees.
At the implant level, another solution could be
the co-axis implant, an implant where
the prosthetic platform is actually
at an angle with the axis of the screw.
This way, a conventional screw retained crown
can be placed, even if the body of the implant
is at an unfavourable angle.
To our patients now, most discussions
with regards to Justin and Gina
evolved around the temporary crowns.
I think most of us agree that temporary implant crowns
would be necessary for these two patients.
By conditioning the soft tissues
with the help of the temporary crowns,
we can actually achieve the optimal emergence profile
and aesthetics for these two patients
and then follow up with permanent crowns.
Some debated whether the temporary crowns
would be best made at the chair side or at the dental lab.
I think it's important to realize
that the basic principles and the design of the temporaries
are the same, regardless if they are made
at the chair side or at the dental lab.
Individual factors such as time, costs,
and needs for aesthetics might influence our decision
to make them chair side or delegate this to the dental lab.
Finally, it was agreed that Mary, on the other hand,
wouldn't require any temporary restoration on her implants.
Instead, some discussion evolved around
whether to place single crowns everywhere
or splint the crowns where possible.
I think today splinting of implant crowns is not necessary,
apart maybe from few exceptional cases of compromised bone,
such as for example, implant crowns in the posterior maxilla
in case of excessive sinus elevation procedures.
Much of the osseointegration is taking place
in the regenerated bone, while implants
in the posterior maxilla are bearing significant load.
In such cases, one could consider splinting
the implant crowns, aiming for a better distribution
of the occlusal load to the bone.
In cases, however, like Mary,
where implants are placed in native bone,
splinting of the implant crowns
would not offer any advantage,
while on the contrary,
it could hinder efficient oral hygiene.
Coming to the end of Module 4,
you should now have a comprehensive understanding
of all the skills, knowledge, and competencies
that are required to design
and execute successful implant treatments.
And maybe we left the best for last, that this,
how to ensure that your successful treatments
will stay successful for a long time,
and that your happy patients will carry on
with the smile you recreated for them
for the rest of their lives.
This, we will discuss next week,
in the last part of our course,
which is about living with dental implants
and also living with dental implant patients.
Thank you very much.
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