0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

治疗指南

头颈癌

Key points

通过临床口腔检查进行筛查后，高风险头颈癌 (HNC) 男性群体的存活率增加
在美国和欧洲，40 岁到 50 岁人群口部癌的发病率在过去十年内增加了一倍
HNC 的综合治疗（包括放射疗法）需要用于进行种植外科的放射治疗硬组织和软组织处理的专门知识和技能

HNC 的流行病学和预后事实

头颈癌的主要代表是头颈部鳞状细胞癌 (HNSCC)。男性发病率高于女性 (2,8:1)。研究证明，人乳头状瘤病毒 (HPV) 与欧洲和美国青年人的 HNC 发病率增加相关。HNC 的常见危险因素是吸烟、滥用酒精及食用槟榔。

HNC 的预后取决于诊断的时间点，且与颈部区域淋巴结的肿瘤扩散密切相关。在诊断时间点，5 年存活率从 80%（I 期）下降到 19%（IV 期）。

HNC 未及早发现以及牙医的角色

由于处于肿瘤晚期阶段 (III-IV) 的患者 60% 预后不良，因此必须及早发现 HNC。研究发现，如果牙医每年至少进行一次口腔检查，则口部癌高风险男性人群的 5 年存活率增加。在进行病理组织学分类之前的 2 周内应该观察到可疑病灶。切除活检类似于判断是确认还是排除 HNSCC 诊断的黄金标准。

HNC 的综合治疗与种植外科

HNC 的综合治疗包括手术切除和辅助放射（化学）治疗。通过重建手术修复颌骨和软组织是基于种植体的修复的前提条件。颌骨和口周软组织 HNC 治疗相关照射可导致骨再生受损及口周组织纤维收缩疤痕。在预照射颌骨中，种植体的总体存活率下降（2-22 年后的总体存活率为 80-90%）。研究证明，总辐射剂量 >55 Gy 可显著提高种植体脱落的风险。头颈部放射疗法的常见晚期并发症是颌骨放射性骨坏死。

临床分类

翻瓣种植全身因素患者评估

治疗指南

Edentulous

放射疗法

放射疗法

口腔癌症患者的康复通常采用外科手术、化疗和放射治疗的联合疗法。放射疗法易于造成纤维化、缺血和口腔干燥。后者的副作用导致粘膜支撑的义齿更加难戴。

种植体修复方案

临床证据表明，可以在接受放射治疗的骨骼中成功植入种植体。元数据分析表明，下颌手术的失败率小于 5%。但长期种植体成活率出现下降，就患者的预期成活时间而言，可能影响治疗期望。

建议在放射治疗后 9 至 12 个月进行种植手术，但支持这种做法的数据十分有限。因此，为了患者早期康复，如果临床情况表明骨骼已充分愈合，可提前手术。

临床医师应考虑两步手术方案，避免种植体部位发生感染，并促进骨结合不受干扰...

全身因素

患者评估

立即观看

Additional resources

视频

对于严重的颌面缺陷重建，有不同区域的骨骼和软组织瓣可用。罗纳博士深入了解了腓骨用于颌面重建的优势，并逐步介绍了预先构建的腓骨瓣重建技术。全面的术前3D规划对于正确地设计手术工具，例如重建接骨板、钻孔和切割指南至关重要。在某个患者治疗案例的支持下，罗纳博士解释了如何将腓骨转换为下颌骨或上颌骨的形状，并用分层皮移植创建新的牙龈，以及如何在植入愈合阶段进行临时性准备。博士总结说，彻底的术前规划以及咬合的驱动是成功重建的关键因素。

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头颈癌

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放射疗法

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丹尼斯•罗纳：预制腓骨瓣重建技术

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头颈癌

HNC 的流行病学和预后事实

HNC 未及早发现以及牙医的角色

HNC 的综合治疗与种植外科

临床分类

Related articles

治疗指南

放射疗法

Additional resources

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丹尼斯•罗纳：预制腓骨瓣重建技术

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