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

伤口闭合

Key points

温和地处理组织是确保无瘢痕愈合的关键
当预计存在创面张力时应采用褥式缝合法
单丝缝线不容易引起粘膜炎症，但会降低患者的舒适度

注意事项

伤口闭合可保护手术部位并影响肉芽组织上角化细胞的迁移，从而确保并加速伤口愈合。一些伤口外翻可最大限度提高表皮对合。最常用的缝合类型是方结缝合，即在一个方向打两个结，然后在相反方向打第三个结。通常，间断缝合可比连续缝合提供更高的抗张强度。

方法概述

使用反三角缝合针可降低组织拖出缝线的风险
垂直穿透粘膜，即与粘膜呈 90° 角
在出口处用无齿镊固定缝针，然后将其从持针钳松开
温和的处理可避免组织缺血
缝线应在 7-14 天后拆除，具体取决于伤口长度、张力和患者的年龄
如果在褥式缝合时具有很高的粘膜张力，则宜延期拆除缝线
女性的口腔粘膜愈合时间长于男性
埋入的可吸收缝线可以留在原处

缝合和粘合材料

肠线不应再继续使用，目前已被性能更好的合成材料所代替
聚乙醇酸 (PGA) 缝线不受低 pH 值的影响。合成缝线通过水解作用去除，这是炎症反应引起的自然结果
丝线比合成材料价格便宜
复丝缝线有利于细菌迁移到组织
复丝替代品：聚乙烯、涤纶、聚丙烯或膨体聚四氟乙烯 (e-PTFE)。这些替代品更加坚固，可以降低所引起的炎症反应，但患者的舒适度较低
氰基丙烯酸酯粘合剂可能宜用于覆盖粘膜性供体部位
基于纤维蛋白的粘合剂在口腔手术中已不再具有任何适应证

临床分类

Related articles

治疗指南

缝线拆除

根据患者的年龄和伤情程度，对粘骨膜伤口的缝线拆除应在 8 到 12 天后进行。即使是可吸收的缝线，在这段愈合时间过后拆除剩余的缝线也是有好处的。

必须清晰确定缝线，用止血钳或棉无齿镊将其向伤口处拉，用剪刀或解剖刀片在靠近粘膜处采取环切术。如果采用了间断缝合，最好先拆除两根缝线中的第一根，以验证伤口是否闭合。如果伤口还未闭合，推迟拆除余下的缝线。

在手术后缝合伤口时，记录缝针的针数是一个良好规程和行医标准 - 当拆除缝线时，将拆除的缝线针数与患者记录上所注的针数进行比较。

在缝线拆除后，用湿润的纱布将粘膜上的残屑

术后护理

治疗指南

药物治疗

根据外科干涉的类型和手术大小，患者可能需要或者想要得到防止疼痛和肿胀的适当药物，例如扑热息痛、阿司匹林 (ASA) 或非甾体抗炎药组 (NSAID)。

副作用：如果使用阿司匹林或者香豆素类凝血剂来防止凝血，最好使用扑热息痛之类的止痛药来缓解疼痛，因为阿司匹林和香豆素与布洛芬之间有冲突。（请参阅凝血紊乱和抗凝治疗上的文章）

应在局部麻醉消退之前开始使用止痛药。

最迟在手术后第二天会出现疼痛缓解；如果没有缓解，患者必须前去就医以寻求控制。

术后护理

治疗指南

术后建议

告知患者在手术后应采取的适当措施。留下出现紧急并发症时可拨打的 24 小时紧急联系电话号码。

将手术后第 1 天或第 2 天、第 8 天 - 第 14 天、第 4 周 - 第 6 周的术后回访安排或委托给转诊牙医。

在手术后，手术部位有一些血液渗出是正常的。将纱布放在手术部位，建议患者全天在纱布上保持稳固而持续的压力。多给患者一些纱布，让其每小时更换纱布。如果出血没有停止，最迟至第二天，患者必须前去诊所就医。

如果放置了愈合基台，向

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