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。
第二周 总结
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Из курса от партнера The University of Hong Kong
口腔种植学 （Implant Dentistry）
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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。
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Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Dear friends, we're now reaching
the end of the second exciting week in the course,
and I want to thank you again for your motivation
and participation to all interesting discussions.
This week we read more than 350 mission statements.
Most of them evolving around the patient
and the patient's needs and wishes.
So I'm sure Professor Lang would be very pleased
with the impact of his lectures.
We also saw the clinical examination of our three patients,
and a lot of discussions evolving around them.
I’d like to tell you that Gina, Mary, and Justin
are actual patients of our department
treated by students and staff in our clinic.
At times, you may see that the documentation
may not be optimal, or conditions not perfect.
We discussed a lot among our staff to decide what cases
to use for that purpose.
Our aim is to introduce you to the practice
of implant dentistry under highest quality conditions,
but using actual treatments which could be performed
in any good clinical practice settings.
As with every treatment process,
there is hardly a right or wrong approach,
and we can achieve our objectives
following many different pathways.
The reason we shared these patient treatments
with you is to stimulate discussion
and to help all reflect on the different ways
one can apply the treatment planning principles
to the individual patient.
One very lively discussion was about bisphosphonates
and the actual risks they pose
for candidates of implant treatment.
This is fully understandable, as especially with regards
to bisphosphonates, we have a lot of hypotheses,
but very little actual evidence
to help us understand the pathogenesis of osteonecrosis.
Some people discussed whether the use
of prophylactic antibiotics is indicated in such patients.
The truth is that there is no evidence,
or known biological mechanism, to suggest any benefit
from prophylactic antibiotics.
Some experimental studies have indicated
possible microbial involvement in the pathogenesis
of osteonecrosis, but that remains a hypothesis.
Some people also discussed the interruption
of the bisphosphonates treatment for a certain period
before the implant placement,
what we would call, a “drug holiday”.
Few professional bodies have in the past
recommended a three-month interruption
of the oral bisphosphonates prior to implant placement.
The truth is that there is no evidence
that any interruption
would lower the risks for osteonecrosis.
In addition, when we look at the pharmacokinetics
of bisphosphonates, one could not easily see
how an interruption of three months
would make any significant difference.
Some experimental studies have indicated
the concentration of bisphosphonates in the blood
as being involved in the pathogenesis of osteonecrosis.
But even so, a “drug holiday” of a few days
would achieve the same outcomes as this of a few months.
To complete the discussion about bisphosphonates,
we recommend you to read the paper
by the American Dental Association Council
on scientific affairs.
This paper estimates the highest reliably reported
prevalence of osteonecrosis to be 0.1%.
In addition, it states that the “drug holiday”
might not reduce the risk of osteonecrosis,
while as of today, there is no validated test
in order to predict the risk of osteonecrosis of a patient.
Luckily, Mary has only taken oral bisphosphonates
for a period of three years.
This means Mary has an elevated risk as compared
to a healthy person, nevertheless,
on the basis of the evidence we have discussed,
the likelihood of an osteonecrosis is very low.
This is well reflected in your response
to this week's tasks as well.
At the same time, as most of you have pointed out,
Mary is a bruxer.
Although bruxism is not a contraindication
for dental implants, it certainly poses challenges,
as it might subject reconstructions to adverse loading,
and increase the risk for technical complications.
We have to take this into consideration in our planning.
How to best counter parafunction is something
that we can discuss further in Modules 4 and 5.
Justin and Gina, on the other hand,
are young and healthy without any systemic compromise.
Does this make them easy cases
to treat with dental implants?
Certainly not.
As they're both young and significantly focused on aesthetics,
they might have very specific expectations
from our treatment.
Dental implants in the aesthetic zone
pose significant challenges, and therefore risk assessment,
patient communication and treatment planning
must be very careful.
As most of you correctly observed,
Gina has quite some way to go
before she's ready to receive implants,
as we need to ensure the perfect gingival health
and oral hygiene conditions.
On the other hand, Justin seems to be already
in a good periodontal condition.
This fact, together with the location
of his fractured tooth, might have encouraged many
to see him as a good candidate for an immediate implant.
I think patients like Justin could certainly value
the immediate aesthetics that would come
from a flapless implant with an immediate temporary crown.
At the same time, however, the local anatomic conditions
are extremely important for the predictability
of our aesthetic outcomes.
The presence of periodontal inflammation
in the site of 21,
and the fact that part of the interdental
and buccal bone was lost, suggested an increased risk
for aesthetic complications, and therefore we decided
to follow the more predictable approach
of early placement six weeks after the extraction,
of which we will discuss more next week.
From mission statement,
to patients' assessment and treatment planning,
we have now discussed many of
the fundamental keys to success in implant dentistry.
Next week, it is time to get into specifics
and see how we can take the critical step
from optimal planning to an optimal execution.
I wish you all a nice weekend and I'm looking forward
to see you more in action next week.
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