Dental Implants for Geriatric People - A Clinical Review

Introduction

Aging is a physiological process. Due to increased age, certain changes in the body can be observed. These changes are attributed to increased cell death, morphological changes in the cell, hormonal changes, and metabolic changes. Teeth loss in elderly people is very common. In the past, removable dentures and teeth-supported fixed prostheses were used to treat such conditions. However, such prosthetic options have their limitations, decreased masticatory force, and difficulty in handling. Also, such options are not suitable for completely edentulous or long edentulous cases. Dental implants are one of the most modern treatment protocols for replacing missing teeth. However, special consideration should be given while providing implant treatment to elderly people.

What Are the Aging Changes Affecting Implant Prostheses?

Age-related changes are classified into two groups. These are systemic changes and local changes. Systemic changes are seen in the whole body, whereas local changes are only seen in oral tissues. These changes affect both the surgical and prosthetic parts of the implant procedure. Also, the long-term success of the implant prostheses depends on these factors.

Local Factors:

Different oral tissues play a pivotal role in the success of the implant prostheses. These tissues are;

1. Alveolar Bone: Alveolar bone or bone present in the maxilla and mandible, which serves as a bed for tooth structure, is the most important factor for implant placement. The alveolar bone undergoes continuous changes to adapt to the changing needs of an individual, such as the increase in occlusal forces due to increased force in the edentulous condition. Such changes are seen in aging people. With increasing age, there is a decline in the alveolar density. Between the ages of 45 to 90 years, the density of the mandibular bone decreases from 1.9 to 1.5 in both males and females. However, it is important to note that throughout this age range, the density of alveolar bone is 8 percent lower in women than in men. Additionally, factors like less osteoblastic activity and mineral loss cause decreased density of bone. Due to this, implants are less stable in geriatric patients, and initial torque is less. That is why bone grafts are often required in such cases.

2. Oral Mucosa: Oral mucosa covers the oral structure. With aging, certain changes in the oral mucosa are observed. These changes are the thinning of the epithelial structure, decreased keratinization, decreased cellular proliferation, and decreased amount of submucosal elastin and fat. These factors are responsible for the loss of epithelial attachment around the implant. Decreased keratinization is responsible for less soft tissue thickening around the implant. That is why soft tissue grafting is essential in elderly people to prevent peri-implantitis.

3. Saliva: Saliva secretion and its consistency changes due to aging. Due to this, the healing property is altered.

Systemic Factors:

Systemic factors and systemic diseases are among the main determining factors for implant-supported prostheses.

1. Elderly women suffer from osteoporosis due to menopause and hormonal changes. That is why the loss of bone around the implant is a major concern.

2. Kidney disorders or kidney transplant patients often suffer from infection susceptibility. In such cases, increased mineral loss is seen. Adequate care should be taken in such cases before implant surgery.

3. Diabetes is responsible for delayed healing. Patients suffering from uncontrolled diabetes are susceptible to increased gingival and periodontal infection. Also, bone loss in such cases is very normal. Additional care should be taken in such cases.

What Are the Advantages of Dental Implants in Geriatric Patients?

The advantages of the dental implant in geriatric persons are;

1. In cases of a fully edentulous arch, implant-supported prostheses are good options as they provide a good alternative to removable dentures.

2. Implant-supported prostheses are given in posterior edentulous regions.

3. Even if teeth structures are present, implant-supported prostheses rather than teeth-supported prostheses are a better option. Teeth-supported fixed prostheses need teeth reduction and additional steps like endodontic treatment or restorative treatments.

4. Implant-supported prostheses have superior retention and support even if there is less ridge support or bone defect.

What Are the Considerations of Implants in Aged Individuals?

The consideration of dental implant prostheses in elderly individuals can be divided into two phases. These are surgical and prosthetic phases.

Surgical Phases:

1. Due to aging, inflammatory responses in older individuals are much higher. This increased inflammatory response causes delayed wound healing and soft tissue healing. In young individuals, the healing period after surgery is usually eight to twelve weeks. However, in elderly people, this period must be longer due to delayed healing.

2. In most cases, elderly persons suffer from different systemic conditions like heart disorders, lung disorders, and kidney disorders. That is why short surgery is needed. During surgery, proper anesthesia and sedation are required.

3. Immediate implants can be a good alternative in geriatric patients. Immediate implant prevents chances of additional surgery. Also, due to medically compromised conditions, there are chances of increased bone resorption. Immediate implant with a bone graft can prevent such bone loss.

Prosthetic Phase:

1. In edentulous cases, implant-supported overdenture is a suitable option. In this type, the minimum amount of implant can be placed to attach the complete denture over it. In this case, previous functional dentures can be used. This is a good treatment option for persons with extremely resorbed ridges.

2. Implant-supported fixed prosthesis for full mouth rehabilitation can be beneficial, and modern treatment options like all-on-4 or all-on-6 can be good treatment options in such cases. A hybrid prosthesis is suitable for persons with increased inter-ridge distance.

3. As the masticatory efficiency in geriatric people is lower, a reduction in the size of the dental arch and prosthetic table is achieved. Concepts like shortened dental arch can be used in such cases.

4. In certain cases, severe bone loss is present. Also, certain elderly individuals may suffer from maxillofacial bone defects. Such cases can be treated with options like a zygomatic implant or pterygoid implant.

Conclusion

Aging is a physiological process characterized by function and morphological changes in the organ and the cell population. These changes can be systemic changes or localized changes seen in the oral environment. Due to increased age, the loss of teeth is common. Such loss can be compensated by the placement of the dental implant. However, due to age-related changes, certain modifications can be made to make implant treatment more successful.