We can begin this presentation by asking the question 我们可以首先讨论一个问题
“What is Osseointegration?" “什么是骨结合（osseointegration)?”
There've been several definitions for osseointegration, 这个名词有很多的定义。
but a commonly used one is a direct, structural 最常用的就是指，正常骨组织和可负载的种植体表面
and functional connection between ordered, living bone 形成直接的，有结构的，
and the surface of a load-carrying implant. 功能性的连接。
Direct bone-to-implant contact was first described 这种种植体－骨组织直接连接的概念，
by Branemark in 1969 首先由Branemark在1969年提出。
and histologically demonstrated by Schroeder Schroeder也从组织学的角度
as functional ankylosis. 证明了这种现象为功能性骨固连（functional ankylosis).
When an osteotomy is prepared, 当我们预备完种植体窝，
a wound healing cascade is initiated 创口开始一系列的愈合反应，
which can be broadly divided into three overlapping phases: 这个过程大概可以分为三个相互重叠的阶段：
inflammation, matrix formation, and remodelling. 炎症，形成基质，重塑。
These phases are common to all healing 这些阶段在所有的愈合过程中都存在，
and involve a large range of cells and molecules, 需要大量的细胞和分子参与其中，
as can be seen on this slide. 正如这张幻灯显示的一样。
Now the key events that lead to osseointegration 那么，实现骨结合的关键
occur at the implant surface, interface. 是种植体表面和骨组织接触的界面。
There are a number of different processes that take place 有很多不同的生理活动都在这层界面进行，
and these are relatively complex. 并且这些活动相对复杂。
The first phase of healing following implant placement 种植体植入到
into the freshly prepared osteotomy 刚预备好的位点时，
involves the formation of a blood clot. 愈合第一个阶段就是形成血凝块。
Initially, there is adsorprion and desorprion of proteins 最初，种植体表面有吸附和
on the implant surface. 解离蛋白的现象。
At the same time an inflammatory cascade is initiated 同时，一系列的炎症反应开始发生，
and the surface of the implant undergoes changes 种植体表面在
as it interacts with the blood clot. 血凝块的影响下也会发生改变。
In the following days, the coagulum is replaced 接下来的几天，血凝块被
by tissue rich in mesenchymal cells, 富含间叶细胞的组织替代，
which will ultimately form the future osteoblasts. 这些组织最终将形成成骨细胞。
These cells enter through the surrounding vasculature, 这些细胞来自于周围的脉管系统
as well as the surrounding bone tissue. 以及周围骨组织。
We also see signs of the formation of blood vessels. 我们也观察到有血管形成。
And furthermore, osteoclasts can be seen 此外，还可以看到破骨细胞
on the surgical edges of the osteotomy 在种植窝边缘，
as the damaged bone is remodelled. 对预备过程中破坏的骨组织进行再塑形。
In the following weeks, we start to see the signs 接下来的几周，我们开始观察到
of mineralized matrix formation 基质逐渐矿化的现象
as the first step towards the formation of a bone matrix. 这也是骨基质形成前的第一步。
Intramembronous bone formation 膜内成骨
leads to the formation of immature woven bone. 形成幼稚编织骨
This woven bone is ultimately remodelled into lameller bone 再接下来的几个月，
in the following months 通过成骨细胞和破骨细胞的共同调控作用，
via the co-ordinated action of osteoblasts and osteoclasts. 这些编织骨最终通过再塑形，形成板层骨。
Based on histological observation 根据组织学的观察，
at the bone-implant interface, 在种植体和骨组织界面，
there are two proposed mechanisms of osseointegration. 关于骨结合的机制有两个假说。
The first is called distance osteogenesis. 第一个叫做远处成骨（distance osteogenesis)。
This is where a new bone is formed 这是指新骨形成
on the surface of existing bone 在原有骨组织的表面（距离种植体表面相对较远），
on the edges of the surgically created osteotomy. 也就是种植体窝的边界。
In these cases, bone is laid down by opposition. 这种情形下，新骨是朝相反的方向逐渐累积。
The second proposed mechanism 第二种机制
is called contact osteogenesis. 叫做接触成骨(contact osteogenesis).
This is where bone cells migrate directly 这是指骨细胞直接迁移到
onto the implant surface. 种植体表面，
They differentiate and produce a bone matrix, 进行分化，进一步形成骨基质，
which then matures into a bone 然后再进一步成熟，形成骨组织。
which is in direct contact with the implant. 这些过程直接发生在种植体表面。
An important consideration 临床关心比较多的另一方面是
is also the establishment of soft tissue integration 种植体周围软组织的形成和整合，
which in many ways is very similar 这在很多方面
between implants and teeth. 和天然牙周相似。
However, there are some important differences. 然而，还是有一些重要的不同点。
Firstly, fibers around implants are parallel 首先，种植体周围的纤维是平行的，
rather than perpendicular to the surface of the implant. 而不是垂直于种植体表面的。
The connective tissue surrounding the implant 种植体周围的结缔组织
is also far less vascular than that found around teeth. 相比于天然牙周围，血管明显减少。
Finally, we need to consider the factors 最后，我们还需要考虑
that can affect the osseointegration process. 一些会影响骨结合过程的因素。
This can be broadly divided into three categories. 这主要分为三类。
These are implant, operator, and patient related factors. 也就是与种植体，操作者，以及患者相关的因素。
In that implant category, 关于种植体，
we need to consider the material that is used, 我们需要考虑的是材料，
with commercially pure titanium being well-established 商业使用的纯钛是值得信赖的、
as having the ability to support osseointegration. 是可以实现骨结合的材料。
Then, we also have the macro level features of the implant, 其次，我们也有一些宏观层面，
as well as, the micro topography of the implant surface 以及种植体表面微观形态方面的因素，
which can both affect the osseointegration process. 都会影响骨结合的过程。
Then we have the operator level factors. 与手术操作者有关的因素
These are usually related 通常是
to the surgical technique being used 手术技术。
with aseptic technique being essential, 无菌操作是关键，
as well as, adequate irrigation 同样的，保证充分地冲洗
to ensure that the osteotomy site is not overheated. 以确保预备位点不要过热。
Finally, there is the patient related factors. 最后，和患者有关的因素，
These relate to both the site 一方面是指与位点相关的，
meaning that the quality and quantity of bone 骨组织的数量和质量要
is to be adequate for implant placement. 充分适合种植体。
Furthermore, the systemic health of the patient 此外，患者的健康状况
needs to be sufficient to support 也要足够支持
the osseointegration process. 骨结合完成。
And factors, such as uncontrolled diabetes 有一些因素，例如控制不良的糖尿病
and severe osteoporosis may 严重的骨质疏松
compromise the osseointegration process. 是可能会影响骨结合形成的。