系统性的评估风险 1

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Del curso dictado por The University of Hong Kong

口腔种植学（Implant Dentistry）

28 calificaciones

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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

种植牙和患者

患者选择和治疗计划是种植牙成功的基石。本模块中，我们将评估所有系统性，解剖学和行为上的风险，并帮助你设计综合治疗计划中的所有步骤，以满足患者的实际需求。

系统性的评估风险 14:51

系统性的评估风险 24:29

评估患者的治疗期望5:54

Conoce a los instructores

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

Today, I would like to start with a historical picture.

Take a close look at the person in the photo.

Notice that she has a closed breathing circuit,

so that not even the air she breathes will escape

in the environment.

You might think that the photo is from a deadly virus outbreak

or a space movie.

Today, it might be hard to believe that the person

in the astronaut suit was actually a dental surgeon

on her way to perform an implant surgery in the late 70s.

After 40 years of research, implant dentistry

has come a long way since that pioneering times.

The indications for implant placements have expanded

and more than 10 million dental implants

are placed worldwide every year.

Does this mean that implants are for every one

with missing teeth?

Certainly not!

Despite the significant progress,

not everyone is suited for dental implants

and careful patient selection

remains still the most important factor to ensure long term success.

From a systemic point of view,

we identify two types of contraindications for dental implants:

the absolute and the relative.

As you guessed, the absolute contraindications are few.

The relative, however, are the tricky situations

where the evidence is not conclusive

and our clinical judgement needs to be well supported

by the current best practices and guidelines.

Let's take a look at the main contraindications

for implant therapy as based on

the currently available evidence.

Highest in the list is: plaque and periodontal inflammation.

Today, we know well that bacterial plaque is the No. 1 enemy

for the long term survival of dental implants.

If bacterial plaque is left to accumulate

on dental implants, inflammation of the peri-implant tissues

in the form of Peri-implant mucositis

or peri-implantitis is the expected tissue response.

Peri-implantitis is a condition that is difficult to manage.

And as we will see in one of the next modules,

it can pose a serious threat to

the survival of dental implants.

Consequently, if your patient is not able to practice

effective oral hygiene, or if he has an active periodontal disease,

do not proceed with dental implants.

The next group is the modifying factors,

factors which would not cause implant failure directly

but they can modify our body's immune response,

amplify the effects of inflammation,

compromise the healing ability of the body,

and increase the risk for failures

either in short or long term.

Diabetes mellitus is among the most well-studied

modifying factors.

Diabetes is a metabolic disorder which is defined

by patient's inability to maintain

a stable blood sugar level.

In reality, however, diabetes can include

a wide array of pathological conditions

and such patients appear to be more susceptible

to periodontal and peri-implant inflammations

while they might also present

with compromised wound healing.

The metabolic control is the key for decision making

in such patients.

And this is expressed by the value of

glycated hemoglobin (A1C), which should be less than 7%

in order to consider the patient in “tight control”.

A patient under “tight control” is a good candidate

for implant placement, while a value bigger than 7%

will indicate that improvement of the metabolic control

is required before we proceed with implant placement.

Similarly, a lot of research has documented

the detrimental impact of smoking

for the longevity of dental implants.

Smokers get a higher risk of peri-implant inflammations,

compromised healing ability, and lower success rates

in the medium and long term.

Again, the effect appears dose related.

Heavy smoking increases the risk for both early failures,

as well as, long term complications.

Although it does not constitute an absolute contraindication,

every patient should be offered

smoking cessation support and advice to quit or reduce smoking

before implant placement.

If smoking persists, the patient must be made aware

of the increased risks

and strict maintenance must be exercised.

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