Effect of Advanced Age and/or Systemic Medical Conditions on Dental Implant Survival - Consensus Statements - Home
Consensus Statement 1: Advanced age is not a contraindication for implant therapy
Advanced age alone (≥75 years) is not a contraindication for implant therapy. This statement is based on 7 prospective studies.
Consensus Statement 2: Peri-implant marginal bone loss in geriatric patients is similar to other age groups after one to 5-year follow-up
Peri-implant marginal bone loss (PI-MBL) in geriatric patients is low and similar to other age groups after one to 5-year follow-up. This statement is based on 7 prospective studies, where PI-MBL was calculated to be between 0.1 mm and 0.2 mm annually over a recall period of up to 5 years and 0.51 mm for the first-year after loading.
Consensus Statement 3: Few studies in implantology focus on geriatric patients and systemic medical conditions
Few studies in implantology focus on geriatric patients (≥75 years) and systemic medical conditions (comorbidities) common in old age.
Consensus Statement 4: Implant survival rate in patients with cardiovascular diseases is similar to patients without CVD
Evidence suggests, that in patients with cardiovascular disease (CVD), including ischemic heart disease, stroke, and hypertensive heart disease, implant survival is similar to patients without CVD. This statement is based on one cross-sectional and one cohort study. The calculated implant survival ranges from 98% to 100% in patients with CVD.
Consensus Statement 5: In patients with head and neck cancer, implant survival may be negatively affected by radiotherapy.
In patients with head and neck cancer, implant survival may be negatively affected by radiotherapy. Treatment protocols for implant placement in irradiated patients have been developed. In oncology patients receiving high-dose antiresorptive therapy (ART), implant surgery carries a high risk for postoperative complications and is contraindicated. High-dose ART is described as any ART treatment administered in oncology patients with bone metastases. In oncology patients, the long-term effects of chemotherapy on oral tissues have not been investigated. This statement is based on 16 studies on radiotherapy and on two studies on ART focussing on the development of medication-related osteonecrosis of the jaw (MRONJ). No studies reported on the effects of chemotherapy alone.
Consensus Statement 6: Implant survival in patients with Sjögren’s syndrome is reported to be very high
Treatment for cancer is commonly associated with hyposalivation. Hyposalivation is also commonly associated with polypharmacy and Sjögren’s syndrome. While implant survival in patients with Sjögren’s syndrome is reported to be very high, the effect of cancer treatment and polypharmacy has not been reported. This statement is based on 5 studies.
Consensus Statement 7: In adult patients with diabetes mellitus type II, high implant survival rates may be achieved
In adult patients with diabetes mellitus type II, high implant survival rates may be achieved. This statement is based on 7 studies for patients in the mean age range of 49.5–64 years.
Consensus Statement 8: Patients with conditions involving neurocognitive impairment such as Alzheimer’s disease can experience high implant survival rates
Patients with conditions involving neurocognitive impairment (unipolar depression, Alzheimer’s disease and other dementias, and Parkinson’s disease) can experience high implant survival rates. This statement is based on 7 studies, including 4 case reports. The mean age ranged from 44 to 83 years and an observation period of 3–72 months.
Consensus Statement 9: No evidence was identified related to respiratory diseases, osteoarthritis or liver cirrhosis common among the elderly in relation to implant therapy.
No evidence was identified related to other diseases that are common among the elderly (WHO, 2015) such as liver cirrhosis, respiratory diseases and osteoarthritis, in relation to implant therapy.
1) Is there an upper age limit for implant therapy?
In geriatric patients, implant therapy may be considered irrespective of age. Implant and prosthesis maintenance must be assured by the patient and/or care provider.
2) Which common comorbidities comprise contraindications for implant placement?
High-dose antiresorptive therapy (ART) poses a serious risk for postoperative complications and is a contraindication for implant surgery. If treated at all, these patients should be managed in a specialist setting.
3) Which common comorbidities comprise risks for implant placement?
Comorbidities such as cancer, diabetes mellitus, and conditions involving neurocognitive impairment may carry risks for implant therapy. An individual risk assessment is necessary before considering implant surgery for these patients. Implant patients with comorbidities should be managed in close collaboration with a supervising physician with regular follow-up. In patients with diabetes mellitus, oral hygiene should be closely monitored along with glycemic control and associated comorbidities of the disease.
4) Which information must be taken into account when planning implant therapy for geriatric patients with common systemic diseases?
While there is no evidence to preclude geriatric patients (≥75 years) from implant therapy it is advisable to perform an individual risk assessment for patients with comorbidities. In geriatric patients, a holistic approach is required which should include assessment of functional dependency in addition to related limitations for the use of implant-supported prostheses and the ability to perform oral hygiene measures. The progression of existing systemic disease and dependency as well as the patient’s life expectancy should be considered in the context of availability of competent care.
5) What are the risks and benefits associated with implant therapy in geriatric patients and patients suffering from the most common diseases in geriatric patients?
Implants may be considered in elderly and medically compromised patients when they can provide substantial functional and psycho-social benefits, which must outweigh the associated risks, cost, and burden of treatment.
6) What public health issues are important to consider for successful implant therapy in geriatric patients?
When older patients lose independence, the availability of trained manpower in the caring professions is a potential limiting factor for implant therapy. Opportunities for education and additional training focused on oral health should be provided for those involved in caring for dependent persons.
Downloads and References
- Effect of advanced age and/or systemic medical conditions on dental implant survival: A systematic review and meta-analysis