天然牙和种植牙－相似性和不同点

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Del curso dictado por The University of Hong Kong

口腔种植学（Implant Dentistry）

28 calificaciones

The University of Hong Kong

口腔种植学（Implant Dentistry）

28 calificaciones

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。

De la lección

种植牙，生物学基础，技术工艺

什么是种植学？这一学科如何开始，又是经历了什么重大突破发展到现在的阶段？什么样的种植体更有益于我们的患者？本模块中，我们将回顾骨结合背后的基本生物学概念，以及其对临床决策的影响。

什么是种植牙？8:59

天然牙和种植牙－生物学相似性和不同点4:58

天然牙和种植牙－相似性和不同点3:59

Conoce a los instructores

Nikos Mattheos
Clinical Associate Professor in Implant Dentistry
The University of Hong Kong

To continue on the differences and similarities

between teeth and implants,

let's take a closer look to the soft tissues

of the periodontium versus the peri-implant tissues.

As we discussed,

the lack of periodontal ligament around implants,

means significant difference in terms of movement,

shock absorption, and perception.

It also means less vascularization,

and poorer blood supply for the peri-implant tissues.

Right on top of the bone, comes the zone of connective tissue

for both implants and teeth.

This connective tissue is highly structured around teeth,

with well organized bundles of fibres,

some of which are well anchored

in the cementum of the teeth on one side,

and the gingival tissues, or the bone on the other.

The zone of connective tissue around implants

is however less vascularized,

and the orientation of the collagen fibres less structured.

Fibres are not firmly anchored on the side of the implant,

instead they are arranged around the implant

like a rubber band.

On top of the connective tissue zone

there is a zone of epithelial cells,

which constructs the junctional epithelium.

These cells are attached on the tooth in the same way

they attach to the implant surface,

and this is the first true barrier

separating the oral environment from the underlying tissues.

The connective tissue zone,

together with the junctional epithelium,

is what we call the biological width,

and this is the necessary zone of tissues

that needs to be established on top of the bone

at all circumstances.

On top of the junctional epithelium starts the sulcus,

a zone where the soft tissues are in proximity,

but not attached in any way to the implant.

The sulcus is a very significant difference

between implants and teeth.

The sulcus around teeth is defined genetically,

and in healthy conditions

is approximately 0.5 to 1 mm.

On the other hand, the sulcus around implants

is mainly determined by the height of the soft tissues,

the local anatomy and the depth of placement of the implant.

Therefore, especially in anterior implants

where the placement is often deep in the tissues

for aesthetic reasons,

a sulcus of 3, 4,or even 5 mm is not uncommon.

Looking closer at this implant

placed in the position of a central incisor,

we can see that the first couple of millimetres

on top of the implant, is the only zone of attachment.

This is the connective tissue and junctional epithelium.

The remaining tissue all the way to the margin

of the soft tissues, is epithelialized sulcus,

and as you see in the mesial and distal sides,

it can be several millimetres deep.

The same can happen in other locations,

such as for example in the posterior maxilla,

as we approach areas where the soft tissues are thicker.

As we can see with the dental floss,

the sulcus around the central incisor

does not extend deeper than a millimetre,

yet, around the neighbouring implant,

the sulcus is several millimetres deep.

The clinical significance of the deep sulcus around implants

is critical, as we need to ensure

that it remains free of plaque and biofilm.

The bacterial biofilm will be created

in the coronal part of the sulcus,

so we need to ensure that the first millimetre or two

of the peri-implant sulcus is accessible to oral hygiene,

and our patient can keep this critical junction clean.

As we see, there are structural,

anatomical, and physiological differences

that make the peri-implant tissues less resistant

to mechanical forces, but also more susceptible

to tissue destruction when inflamed.

And this will have a very important role

in the diagnosis of peri-implant tissue inflammation,

as we will see later in the course.

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