Ayşe Sümeyye Akay and Volkan Arısan

Additional information is available at the end of the chapter Ayşe Sümeyye Akay and Volkan Arısan

http://dx.doi.org/10.5772/intechopen.70182 Additional information is available at the end of the chapter

#### Abstract

As a result of the increase of the life expectancy, elder people live with diverse diseases or conditions like systemic disorders, immune-related disorders, and psychiatric issues. Consecutively, practicing clinicians are faced with serving dental implant treatments in such a population comprised of medical and demographic characteristics. Most commonly, implant therapy is performed among patients above middle ages; therefore, clinicians often encounter medically compromised patients. The patients are usually with adverse conditions like bleeding disorders, bone diseases, cardiovascular disease (CVD), and/or immunologic conditions like cancer therapy, steroid or immunosuppressive or antiresorptive medication, alcoholism, smoking, and many others. Nevertheless, only few conditions could be stated for contraindication to dental implant therapy. Besides the broad range of the mentioned dental implant comorbidities smoking seems less prevalent compared to the general population. Dental implants in smoking patients are certainly affected in relation to the failure rate, marginal bone loss, and some other risks of postoperative complications. Hence, smoking or other similar conditions could be accounted as a chronic systemic disorder just like diabetes mellitus or drug usage. Briefly, it seems that establishing the medical and demographic conditions prior to implant therapy along with controlling the systemic diseases or disorders may be more important than the presence of compromise.

Keywords: systemic diseases, dental implant success, contraindication

### 1. Introduction

Dental implant (DI) is broadly considered to be the ideal treatment of the tooth loss, which is mostly required in the aged population [1, 2]. The prevalent age-range for implant therapy has been reported above 40 years [2] or between 51 and 60 years [1], thus the patients who required

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

dental implant therapy are usually associated with systemic comorbidities. For both patients' and clinicians' benefit, systemic comorbidities of the patient should be well-diagnosed before DI therapy. Besides, treatment plan and patient selection should be carried out with reference to the clinical evidence. Patients should be ensured to inform thoroughly about the risks and precautions.

Author, year, study

Manor et al., 2009, Retrospective cohort [7]

Lee et al., 2010, Prospective [8]

Busenlechner et al., 2014, Retrospective

Becker et al., 2015, Prospective [10]

Neves et al., 2016, Retrospective [2]

Prasad et al., 2016, Retrospective cohort [11]

Hoeksema et al., 2016, Prospective comparative [5]

Srinivasan et al., 2016, Sys. Rev., meta-analysis [4] (includes 11 prospective studies)

[9]

Followup

2–20 years

2.7 years (mean)

7.3 years (mean)

5.7 years of mean

10 years

1–10 years No. of patients No. of

541 subjects are aged >60 years (1140 total)

35 subjects are >70 aged geriatric MCP with controlled systemic disease

528 subjects are aged >40 years (721 total MCP subjects with the age range of 20–87)

Approximately the half of 1091 total subjects is aged >60 years

(1) 52 subjects with age range of 35–50 years (2) 53 subjects with age range of 60–80 years

206 subjects are aged ≥65 years

ND (3998 total)

ND (1918 total)

(1) 104 (2) 106

6 years 194 (2 equal groups for evaluating early and late failures)

8 years 2632 subjects are >50 years (61% out of 4316 total)

7 years 31 aged subjects implants

ND (4680 total) SR of implant Peri-implant

294 – Assigned as minor/

82% (for aged >60 years)

ND 95.3% for the

84 94.6% for 13

age >70 years

patients with 40 implants

92.7% for the age <40, 85.3% for age >40, and 86.5% is overall SR (patient based)

96.4% (implant based), 94.6% (patient based)

(1) 97.1% (2) 93.4%

480 97.7% (1st

year), 96.2% (5th year), 91.2% (10th year)

pathology

Dental Implants in the Medically Compromised Patient Population

moderate/major

118 – MBL: 0.27 mm Old age is not a risk

MBL: 0.1 mm (difference of 0–7 years' follow-up) PD: 2.6 mm

33.8% of patients and 12.7% of implants have pathology

MBL: 0.1 mm (1st year), 0.7 mm (5th year), 1.5 mm (10th

PD: 3 mm for both groups at 10th year

MBL: 0.1–0.3 mm (1st year), 0.7 mm (5th year), 1.5 mm (10th year)

year)

MBL

Conclusion

(RR = 2.24)

>60 years have higher risk for implant failure 61

Old age may be a risk factor for late failures and risk is also more likely for men and posterior of jaws

factor for peri-implant MBL (p = 0.484)

is not associated with long-term implant

DI is successful in aged population, and MBL changes are comparable with the younger populations

>40 age is a risk factor of implant loss (risk is higher for more than two times than <40 age), but is not a risk for peri-implant pathology

shown to have an increased risk of implant failure

Mandibular twoimplant OD is equally successful in older patients compared with the younger patients without significant differences of the parameters

Age alone should not be a limiting factor for DI therapy Reported complications are found inadequate for a meta-analysis

– Patients who are aged

http://dx.doi.org/10.5772/intechopen.70182

– Old age over 70 years

– Age over 65 years is

success

design

Moy et al., 2005, Retrospective cohort [6]
