Implants and Older Patients

Implants and Older Patients

Due to advances in modern medicine, there is an ever increasing demographic trend towards a larger number of older patients. Many of these patients are missing teeth for various reasons. Conventional replacement of missing teeth, such as crown and bridge therapy and removable dentures, may not be the preferred method of tooth replacement for many of these patients.

When treatment planning for tooth replacement, patients should be presented with all possible treatment options regardless of age. Dental implant therapy has proven to be a predictable method of permanent tooth replacement. Preliminary results of a retrospective study of over 200 patients over 65 years of age, conducted at Pi Dental Center, Fort Washington, PA are consistent with the results of previous studies indicating that age is not a factor in the success of dental implants. The following are two brief clinical reports representative of the 200+ older patients treated with Brånemark osseointegrated dental reconstructions at Pi Dental Center over the past five years.

 

Torus Necessitates Maxillary Implant Rehabilitation

Balshi T

Treatment of older patients presents distinct challenges in prosthodontic rehabilitation. One such example is a 90 year old female patient who was referred to Pi Dental Center for the treatment of a failing maxillary fixed prosthesis. Due to her inability to wear a removable denture, it was a challenge to provide her with continued fixed prostheses throughout the implant treatment reconstruction.

The patient's medical history revealed rheumatism, arthritis and recent frequent occurrences of pneumonia. She was sensitive to Penicillin and was medicated with Prednisone every other day.

The patient's dental history included fixed prostheses restoring both mandibular posterior quadrants and a failing, mobile fixed prosthesis and multiple missing teeth in the maxilla.

The maxillary left molars were periodontally and restoratively hopeless. Radiographic examination of the maxillary teeth could only be accomplished with panradiographic (Fig 1) due to the enormous torus palatinus which totally obliterated the palate. This extosis extended beyond the occlusal surface and incisal edges of the maxillary dentition. The patient was reluctant to consider surgical intervention to remove this overgrowth of bone.

The treatment plan prescribed the Brånemark method of osseointegration (Class III modification). Three of the remaining natural teeth (#'s 7, 10, and 15) were selected to serve as temporary abutments to support a fixed prosthesis (Fig 2). A wire reinforced heat processed acrylic provisional restoration was prepared in advance.

Using local anesthesia, teeth #'s 6,8,9,11 and 16 were removed. Brånemark implants were placed in the pterygomaxillary region bilaterally and six additional implants were inserted in the anterior region. Following implant placement and full flap closure the provisional fixed prosthesis was cemented. The patient was comfortable postoperatively with little swelling or ecchymosis.

Following a five month healing period, angulated abutments were placed on the six anterior implants and a standard abutment on the pterygomaxillary implant on the left side. Its counterpart on the right side was not osseointegrated and was therefore removed.

A porcelain fused to gold fixed prosthesis (Fig 3 & 4) was constructed using the seven Brånemark implants. A short cantilever provided additional function and esthetics for the right side (Fig 5 & 6).

The patient is able to perform adequate oral hygiene and has excellent masticatory function. She reports delight in chewing food without discomfort or fear of loosing her maxillary teeth.

Patients in later years are indeed good candidates for osseointegrated implants ad modem Brånemark. This 90+ year old patient had excellent bone growth response to the titanium implants permitting a solid fixed restoration. This certainly is a significant contribution to maintaining her quality of life and the ability to function orally.

Acknowledgement: Fort Washington Dental Lab, Inc. for construction of the porcelain fused to gold tissue integrated prosthesis.

Osseointegration for Elderly Patients

Zarb G, Schmitt A

Evidence has shown that conventional removable dentures are poor substitutes for missing natural teeth. Essentially a conventional removable denture becomes quite a compromise of quantitative and qualitative support. Studies have shown a significant number of patients in all age groups experience difficulty in obtaining comfortable and efficient oral function with a removable prosthesis. Several studies have shown the relationship between adequate oral function and proper digestion and nutrition; and where oral function is compromised, so too is nutritional status.

Because the life expectancy of edentulous patients will increase, the risk of denture dissatisfaction and its functional implications can only be prolonged. Published clinical data for osseointegrated dental implant treatment of maladaptive patients has led to the clinical impression that a stable prosthesis could preclude most of the problems associated with complete denture wearing. The original studies on osseointegrated dental implants were done on maladaptive edentulous patients. Age did not enter into either the inclusion or exclusion criteria. Any geriatric patient whose systemic health did not preclude a minor oral surgical procedure was considered a candidate for osseointegration. Previous studies have proven that age dependent differences in wound healing do not appear to effect the outcome of surgery in elderly subjects. And although a large percentage of post menopausal women may have or are developing osteoporosis, a recent study concluded that osteoporosis is not a contraindication for prescribing osseointegration.

The present study involved the overall results on Brånemark implants placed during the Toronto Study from 1979 to 1992 and compared those results to that of the subgroup of patients whose ages ranged from 60 to 81 years. Surgically related problems and complications encountered with the elderly patients in this study were similar to those reported in other studies and were not frequent in the elderly patient group. Data gathered from previous articles indicated that the survival rate for implants placed in elderly patients was similar to that of implants placed in other age groups.

To date this clinical study from Toronto supports the conclusion that neither advanced age itself, nor the diminished levels of oral hygiene that often accompany it, are alone contraindications to the prescription for treatment with osseointegration. Until recently being elderly and edentulous has undermined the quality of life for the patient. However patients who were elderly at the time their implants were placed, and patients who have grown elderly since implant insertion, have functioned successfully with implant supported prostheses of various designs throughout the years. J Prosthet Dent, 1994; 72:559-568.

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