Advances in medicine have led to longer life expectancy for both men and women. It is well known that all developed countries are facing a growing proportion of older people and, consequently, all the health problems associated with ageing. Studies have shown that, despite better prevention among younger people, the need for prosthetic restorations will continue to grow and, as the population requiring such restorations becomes more informed, so will the demand for higher-quality restorations.
Studies indicate that the function and aesthetics of all types of prosthetic restorations can be improved with the use of dental implants: bite force increases, chewing efficiency is greater and masticatory movements are better coordinated … Consequently, the likelihood of malnutrition in edentulous patients is reduced, the effect on other parts of the digestive tract is positive, systemic diseases may therefore improve, the need for medication for these conditions decreases, quality of life improves and patient satisfaction rises. The facts indicated are also interconnected in the opposite direction, making the overall effect of therapy even greater.
When placing dental implants in older patients, we encounter specific issues. Although general perceptions may discourage older people from choosing the procedure, professional evidence indicates that age itself has no effect on the success of the surgical procedure or on implant survival. Statistics show that the ten-year survival rate of implants in people over 60 is between 90 and 95%. It is true, however, that the likelihood of systemic diseases increases with age, and these can affect the success of implant treatment.
Cardiovascular diseases are no longer considered an obstacle that would prevent or endanger dental implant treatment. Before surgery, we most often consult the treating specialist, prepare the patient appropriately for the procedure and avoid risks that the intervention could otherwise present. After the age of sixty, on average every fourth older person suffers from the consequences of diabetes, most commonly type II. Even in patients who successfully control the disease with diet, tablets or injections, specialists around the world observe a somewhat higher proportion of lost implants, but not high enough for implants to be discouraged solely because of the disease. The duration of diabetes plays an important role: the longer a patient has diabetes, the greater the likelihood of failure. Five to ten percent of people between fifty and seventy years of age suffer from the consequences of osteoporosis. The disease alters bone metabolism and could theoretically affect the success of dental implant treatment, but it has been found that only the local quality of bone in the jaw is important for success, and this usually does not show the same changes as bone elsewhere in the body. Certain habits have a much greater impact on treatment success than the serious medical conditions described so far. Especially in older patients, we must not overlook the effect of smoking. All studies conducted to date indicate that smoking greatly increases the likelihood of inflammation of the tissues around an implant (peri-implantitis) and can thus lead to implant loss. The same cannot be claimed for alcoholism. Good oral-hygiene habits are the basis for long-term implant survival. All research to date has shown an association between poor hygiene and premature implant loss. Among older people in particular, many are unable to maintain dental implants properly because of reduced motor or other abilities, and this is a factor that should not be ignored when planning such treatment. Oral hygiene in residential homes for older people is often not the first priority, which is entirely understandable given the circumstances, and the same is true in the families of older people. From our own practice, we can say that attention to hygiene monitoring is essential, and repeatedly alerting caregivers to the issue is a key activity if we decide to perform the procedure in older patients.
Depending on the issues that increase the risk of failure, we decide between standard prosthetic treatment and implant-supported treatment. In every case, we seek solutions that, with the least effort required from the patient, the lowest risk of failure and the smallest financial investment, will lead to optimal prosthetic treatment with dental implants. The most common solution we have used so far, and one that is also most frequently described in the international literature as an optimal approach, is treatment of the edentulous lower jaw with two implants and a complete denture. Because of severe bone resorption and loss of vertical components, the mandible loses the ability to provide sufficient retention for a lower complete denture. Conventional dentures therefore become unstable. Two implants placed in the area where bone quality is best and where the likelihood of technical errors and therefore complications is low provide sufficient retention for the denture. The time burden of the procedure is minimal, healing of the surgical site is short and the implants can be loaded relatively quickly. We most often use the existing complete denture, which further reduces the burden on the patient, while occlusal comfort (bite habits) remains unchanged. This is crucial because older people generally adapt more slowly to any changes.
Given the taboos surrounding dental implant treatment for older people, our task is to inform and encourage them in taking steps that can prolong their lives and improve their quality of life.
Studies indicate that the function and aesthetics of all types of prosthetic restorations can be improved with the use of dental implants: bite force increases, chewing efficiency is greater and masticatory movements are better coordinated … Consequently, the likelihood of malnutrition in edentulous patients is reduced, the effect on other parts of the digestive tract is positive, systemic diseases may therefore improve, the need for medication for these conditions decreases, quality of life improves and patient satisfaction rises. The facts indicated are also interconnected in the opposite direction, making the overall effect of therapy even greater.
When placing dental implants in older patients, we encounter specific issues. Although general perceptions may discourage older people from choosing the procedure, professional evidence indicates that age itself has no effect on the success of the surgical procedure or on implant survival. Statistics show that the ten-year survival rate of implants in people over 60 is between 90 and 95%. It is true, however, that the likelihood of systemic diseases increases with age, and these can affect the success of implant treatment.
Cardiovascular diseases are no longer considered an obstacle that would prevent or endanger dental implant treatment. Before surgery, we most often consult the treating specialist, prepare the patient appropriately for the procedure and avoid risks that the intervention could otherwise present. After the age of sixty, on average every fourth older person suffers from the consequences of diabetes, most commonly type II. Even in patients who successfully control the disease with diet, tablets or injections, specialists around the world observe a somewhat higher proportion of lost implants, but not high enough for implants to be discouraged solely because of the disease. The duration of diabetes plays an important role: the longer a patient has diabetes, the greater the likelihood of failure. Five to ten percent of people between fifty and seventy years of age suffer from the consequences of osteoporosis. The disease alters bone metabolism and could theoretically affect the success of dental implant treatment, but it has been found that only the local quality of bone in the jaw is important for success, and this usually does not show the same changes as bone elsewhere in the body. Certain habits have a much greater impact on treatment success than the serious medical conditions described so far. Especially in older patients, we must not overlook the effect of smoking. All studies conducted to date indicate that smoking greatly increases the likelihood of inflammation of the tissues around an implant (peri-implantitis) and can thus lead to implant loss. The same cannot be claimed for alcoholism. Good oral-hygiene habits are the basis for long-term implant survival. All research to date has shown an association between poor hygiene and premature implant loss. Among older people in particular, many are unable to maintain dental implants properly because of reduced motor or other abilities, and this is a factor that should not be ignored when planning such treatment. Oral hygiene in residential homes for older people is often not the first priority, which is entirely understandable given the circumstances, and the same is true in the families of older people. From our own practice, we can say that attention to hygiene monitoring is essential, and repeatedly alerting caregivers to the issue is a key activity if we decide to perform the procedure in older patients.
Depending on the issues that increase the risk of failure, we decide between standard prosthetic treatment and implant-supported treatment. In every case, we seek solutions that, with the least effort required from the patient, the lowest risk of failure and the smallest financial investment, will lead to optimal prosthetic treatment with dental implants. The most common solution we have used so far, and one that is also most frequently described in the international literature as an optimal approach, is treatment of the edentulous lower jaw with two implants and a complete denture. Because of severe bone resorption and loss of vertical components, the mandible loses the ability to provide sufficient retention for a lower complete denture. Conventional dentures therefore become unstable. Two implants placed in the area where bone quality is best and where the likelihood of technical errors and therefore complications is low provide sufficient retention for the denture. The time burden of the procedure is minimal, healing of the surgical site is short and the implants can be loaded relatively quickly. We most often use the existing complete denture, which further reduces the burden on the patient, while occlusal comfort (bite habits) remains unchanged. This is crucial because older people generally adapt more slowly to any changes.
Given the taboos surrounding dental implant treatment for older people, our task is to inform and encourage them in taking steps that can prolong their lives and improve their quality of life.