Lang N P, De Bruyn H
The University of Hong Kong, Hong Kong SAR, China.
Eur J Dent Educ. 2009 Feb;13 Suppl 1:19-23. doi: 10.1111/j.1600-0579.2008.00540.x.
This paper provides arguments for the introduction of implant dentistry into the undergraduate curriculum. The survival of teeth is very high when disease is diagnosed and treated properly and maintenance is taken care of. Nevertheless, tooth replacements by fixed and removable prostheses are highly prevalent. It is expected that dentists will face a dramatically increased need to care for elderly patients and partially edentulous patients. Hence, the demand for implant reconstructions will be substantial and more appropriately trained and competent health professionals will be needed. Increasing demands of the patient regarding aesthetics and function will influence the demands for implant therapy. The improvement of oral function and subjective chewing comfort, the preservation of tooth structures or existing reconstructions and the replacement of missing, strategically important teeth are major indications for implant placement. From both a biological and an economical point of view, the single tooth replacement with an implant is the first choice in situations with no or minimally restored neighbouring teeth compared with conventional bridgework. Stability of full dentures represent a major problem especially for the mandible. It is well documented that placement of two implants supporting an overdenture substantially improve chewing capacity, increase quality of life and is a simple and cost-effective treatment thus rendering such treatment a 'standard of care' procedure. There is no doubt that dental students should learn to incorporate the indication of oral implants in their overall treatment planning. Therefore, they will have to understand the basic aspects of healing and tissue integration, basic biomechanical and material science principles as well as surgical and prosthetic techniques. They will have to be able to monitor continuously the peri-implant tissues, render appropriate supportive therapy and cope with biological and technical complications. While it is evident that the surgical procedure per se may require additional competence, the remainder of the aspects mentioned should be taught in the dental curriculum. This should include the attribution of responsibility for maintenance of implants and handling of biological and technical complications. Moreover, it is desirable to include the surgical technique for implant placement for 'straightforward' cases into the dental curriculum. The levels and limitations to which the various aspects of implant dentistry and related skills are to be taught are determined by the academic community. Obviously, ethical and legal aspects of implant dentistry should not be forgotten.
本文为将种植义齿学纳入本科课程提供了论据。当疾病得到正确诊断和治疗并进行维护时,牙齿的留存率非常高。然而,固定和可摘局部义齿修复牙齿的情况却极为普遍。预计牙医将面临照顾老年患者和部分牙列缺损患者的需求大幅增加的情况。因此,对种植修复的需求将很大,需要更多训练有素、能力胜任的健康专业人员。患者对美学和功能要求的不断提高将影响对种植治疗的需求。改善口腔功能和主观咀嚼舒适度、保留牙体组织或现有修复体以及替换缺失的、具有重要战略意义的牙齿是种植体植入的主要适应证。从生物学和经济学角度来看,与传统桥体修复相比,在邻牙未修复或修复极少的情况下,用种植体进行单颗牙修复是首选。全口义齿的稳定性是一个主要问题,尤其是在下颌。有充分的文献记载,植入两颗种植体支持覆盖义齿可显著提高咀嚼能力、提高生活质量,并且是一种简单且经济有效的治疗方法,因此使这种治疗成为一种“标准治疗”程序。毫无疑问,牙科学生应学会在整体治疗计划中纳入口腔种植体的适应证。因此,他们必须了解愈合和组织整合的基本方面、基本生物力学和材料科学原理以及外科和修复技术。他们必须能够持续监测种植体周围组织,提供适当的支持性治疗并应对生物学和技术并发症。虽然显然手术操作本身可能需要额外的技能,但上述其他方面应在牙科课程中教授。这应包括种植体维护责任的归属以及生物学和技术并发症的处理。此外,将“简单”病例的种植体植入手术技术纳入牙科课程是可取的。种植义齿学各个方面及相关技能的教学水平和局限性由学术界确定。显然,种植义齿学的伦理和法律方面也不应被忽视。