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How to manage risks

Augmentation procedures for geriatric patients

Old age is not a contraindication for bone augmentation and implant placement, but patient and technique factors have to be considered.

Since 2010 global demographics have revealed an ever-increasing elderly population.

Aged patients, who tend to present with partial or total tooth loss, inevitably need more complex and higher quality dental rehabilitation, including dental implant therapy.

Nevertheless, a recent systematic review provides evidence that aged patients receiving dental implants have excellent implant survival rates, clinically acceptable marginal bone loss changes and minimal complications.1

Therefore, it seems that advanced age alone should not be a contraindication for dental implant therapy, and implants can be a recommended treatment option in the rehabilitation of elderly, edentulous patients who are in reasonably good health and want to improve their oral function and quality of life.2

Systemic conditions

However, aged patients frequently suffer from one or more systemic diseases, especially diabetes and bone-related disorders, most of which not only restrict the surgical procedures that can be performed but also compromise implant success.

Before choosing an appropriate therapy, it is extremely important to obtain a thorough medical history and a detailed report of systemic conditions. Also, a comprehensive risk assessment should be conducted on a case-by-case basis. Safe surgical procedures and implant success can be expected only if the overall conditions of aged patients are considered.

Bone substitute to minimize surgical trauma

When bone augmentation is unavoidable, instead of autologous bone, xenogenic or alloplastic bone substitutes with comparable clinical outcomes like Geistlich Bio‑Oss® can be recommended. Donor site morbidity is avoided, and surgery time is reduced.3 Collagen membranes such as Geistlich Bio‑Gide®, with its biocompatibility and ease of use, are also effective in dealing with surgical complications like Schneiderian membrane perforations.

  1. Srinivasan M, et al.: Clin Oral Implants Res 2017;28(8):920-930.
  2. Liu JY, et al.: J Oral Rehabil 2012; 39(8): 591–99.
  3. Chen ZF, et al.: Chinese J Oral Maxill Surg 2016, 26(1): 1–12.
  4. Erdoğan O, et al.: Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104(6): 738.e1–13.
  5. Giovannacci I, et al.: J Craniofac Surg 2016; 27(3): 697–701.
  6. Chen ZF: Research and clinical application of dental implant therapy.[Book], 2010, Beijing, China.
  7. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy: JAMA 2001; 285(6): 785–95.

Clinical case pictures: Zhuofan Chen, Zhipeng Li, Guanghua. SYSU

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