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Is old age a risk factor for dental implants?

Authors:

Abstract

Patient's condition is distinctly different among individuals especially in the elderly. Dental implant failure seems to be a multi-factorial problem; therefore, it is unclear that aging itself is a risk factor for the placement of implants. This review reorders and discusses age-related risk factors for the success of dental implants. In dental implant treatment, chronological age by itself is suggested as one of the risk factors for success, but it would not be a contraindication. In general, reserved capacity of bone and soft tissue make it possible to establish osseointegration in the long run. Rather than aging itself, the specific nature of the disease process, such as osteoporosis or diabetes, and local bone quality and quantity at the implant site, mostly related to aging, are more important for successful dental implant treatment. This review revealed a shortage of published data for the survival and success of dental implants in older patients. More studies useful for evidence-based decision making are needed to assess the survival and success of dental implants for aged patients with a compromised condition.
MINI REVIEW
Is old age a risk factor for dental implants?
Kazunori Ikebe *, Masahiro Wada, Ryosuke Kagawa, Yoshinobu Maeda
Department of Prosthodontics and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka,
Suita, Osaka 565-0871, Japan
Received 5 September 2008; accepted 3 February 2009
1. Introduction
Previous researchers have reported prognostic risk factors for
dental implants, including compromised general health (e.g.,
osteoporosis), smoking, implant location (e.g., maxilla, pos-
terior), bone quality and quantity in the recipient site, implant
length and immediate loading of the implant [1,2].
Patient’s condition is distinctly different among indivi-
duals especially in the elderly. Implant failure seems to be a
multi-factorial problem; therefore, it is unclear that aging
itself is a risk factor for the placement of implants. This
review reorders and discusses age-related risk factors for the
success of dental implants.
2. Chronological age
Age as a prognostic factor in implant success has been dis-
cussed by several authors. Older patients, theoretically, have
potentially longer healing times, more systemic health fac-
tors, and the likelihood of poorer local bone conditions [3].
In an animal study on rats, aged 6 weeks (young group), 12
weeks (adult group), and approximately 2 years (old group),
the young group showed that new trabecular bone formed
actively around the implant, and good bone contact was
achieved more rapidly than in the adult group. In contrast,
in the old group both the quantity of newly formed trabecular
bone around the implant and bone contact were less than in
the other groups. The results suggest that the rate and
volume of new bone formation around implants decrease
with increasing age [4].
However, although some studies on implant treatment in
the edentulous elderly suggested that age may be associated
Japanese Dental Science Review (2009) 45, 59—64
KEYWORDS
Dental implant;
Aging;
Jaw bone;
Diabetes;
Osteoporosis
Summary Patient’s condition is distinctly different among individuals especially in the elderly.
Dental implant failure seems to be a multi-factorial problem; therefore, it is unclear that aging
itself is a risk factor for the placement of implants. This review reorders and discusses age-related
risk factors for the success of dental implants. In dental implant treatment, chronological age by
itself is suggested as one of the risk factors for success, but it would not be a contraindication. In
general, reserved capacity of bone and soft tissue make it possible to establish osseointegration in
the long run. Rather than aging itself, the specific nature of the disease process, such as
osteoporosis or diabetes, and local bone quality and quantity at the implant site, mostly related
to aging, are more important for successful dental implant treatment. This review revealed a
shortage of published data for the survival and success of dental implants in older patients. More
studies useful for evidence-based decision making are needed to assess the survival and success of
dental implants for aged patients with a compromised condition.
#2009 Japanese Association for Dental Science. Published by Elsevier Ireland. All rights reserved.
* Corresponding author. Tel.: +81 6 6879 2956 (Business)/72 761
0596 (Home); fax: +81 6 6879 2957.
E-mail address: ikebe@dent.osaka-u.ac.jp (K. Ikebe).
availableonlineatwww.sciencedirect.com
journal homepage: www.elsevier.com/locate/jdsr
1882-7616/$ — see front matter #2009 Japanese Association for Dental Science. Published by Elsevier Ireland. All rights reserved.
doi:10.1016/j.jdsr.2009.02.001
with a higher implant failure rate [5,6], the majority of
previous studies indicated that increasing age alone is not
a contraindication for implant treatment (Table 1)[7—14].
The findings that the use of implants in older patients was not
contraindicated suggest that bone has a reserved capacity for
osseointegration.
Moy et al. [6] studied a relatively large group of patients
who had been operated on by an experienced surgeon and
found that advanced age increased the risk of implant fail-
ure; patients older than 60 years were twice as likely to have
adverse outcomes. Brocard et al. [5] analyzed cumulative
success rates in a 7-year longitudinal study in a private
practice setting with the same type of implant and found
that in patients older than 60, only a relatively small number
of implants remained.
In contrast, Meijer et al. [13] reported that Plaque Index,
Gingival Index, Bleeding Index and bone loss after 3 years
were not significantly different between younger and older
patients. The authors concluded that the clinical perfor-
mance of implant-supported overdentures in the mandible
is equally successful in younger and older patients. Mesa
et al. [14] reported that in a bivariate model, associations
were found between primary stability failure and age, sex,
smoking, oral and periodontal health status, maxillary or
mandibular placement, placement of tooth site, bone qual-
ity, and implant diameter and length. However, in a multi-
variate logistic regression model, only females (odds ratio:
1.54), implants placed in the maxilla (odds ratio: 2.7) and
implants shorter than 15 mm (odds ratio: 1.49) showed sig-
nificantly higher risk of primary implant failure. These results
suggested that age is a confounding factor associated with
stability failure of implants. August et al. [15] showed that
from a retrospective review of records at four clinical sites,
no age effect on implant success was shown between the
older and younger male groups, nor was there a significant
difference between premenopausal women and estrogen-
supplemented postmenopausal women, although there was
a significant difference between young and postmenopausal
women. Therefore, the age variable appears to be less of a
factor than does estrogen status.
3. Systemic factors
Dental implants and implant-supported prostheses are fea-
sible treatment options for older patients; however, they
present a number of problems not encountered in younger
patients, including general health problems that might con-
traindicate surgery [1]. However, absolute medical contra-
indications to implant are rare. Implant surgery presents the
same contraindications as any bone surgery, so it is very
important to identify patients who have general pathoses,
such as coronary diseases, anticoagulant treatment, dia-
betes, and osteoporosis [1].
However, patients with contraindications to implant sur-
gery never make an impact on the success or failure rate in
clinical statistics because patients with these general health
problems never undergo an operation and would not be
included in calculating the success rate.
3.1. Physiologic aging
The clinician must be aware of the physical, metabolic, and
endocrine changes associated with aging and how these
changes may affect implant treatment [11]. The human
skeleton accumulates bone up to an age of approximately
30 years and then gradually starts to lose bone [16].In
Table 1 Studies reporting implant failure rate compared between in young and old patients.
Authors Published
year
Observed
period (years)
Age group
(years)
Sample size
(persons)
Failure rate Statistical
significance
Remarks
Bryant and Zarb 1998 5—25 months 26—49 43 13.5 P>0.05 Same clinic
60—74 39 8
Brocard et al. 2000 7 <40 17.5 P<0.02 Multicenter
40—60 440 11.4
60<21.9
Engfors et al. 2004 5 <79 115 Maxilla: 7.0,
mandible: 0.5
P>0.05 Edentulous
patients
80 133 Maxilla: 7.4,
mandible: 0.3
Same clinic
Moy et al. 2005 Up to 20 <40 181 8.8 P<0.05 Same surgeon
40—59 418 13.3
60—79 499 17.9
79<42 16.7
Noguerol et al 2006 10 <40 117 4.3 P<0.05 Same clinic
41—50 347 6.3
51—60 357 7.0
60<263 1.1
Kinsel and Liss 2007 2—10 59 12 4.9 P>0.05 Edentulous patients
60<31 4.4 Immediate loading
Same surgeon
60 K. Ikebe et al.
general, human bone mineral density (BMD) reaches a peak at
age 25—30 years [17]. With increasing age, bones become
weaker as a consequence of a reduced amount of bone tissue
[18]. Age-associated bone loss is linked with an uncoupling of
osteoblastic and osteoclastic activity in favor of osteoclasis
[18]. Reduced estrogen bioavailability is the only indepen-
dent predictor of bone mass in both men and women [19].
For women, menopause is associated with decreased
estrogen levels, which in turn lead to increased bone resorp-
tion. The third National Health and Nutrition Examination
Survey (NHANES III, 1988—1994) of the USA indicated that
during the decade from 50 to 60 years, women lost about 10%
of their hip BMD, compared to only 2% for men [20]. After age
70, men start to lose BMD at a similar rate to women. Two
distinct syndromes of involutional osteoporosis were distin-
guished [21]: Type I or ‘‘postmenopausal’’ osteoporosis, in
which a loss of trabecular bone is predominant, resulting
mainly in fractures of the vertebrae and wrist, and Type II or
‘senile’’ osteoporosis, in which both cortical and cancellous
bone are lost, resulting in hip fractures as well.
Clinical studies in humans showed a delayed course of
bone healing with increasing age [22]. A reduced number of
osteogenic stem cells, their reduced proliferation and differ-
entiation potential, and reduced systemic or local blood flow
have been discussed as reasons for this [23]. The time
required for radiographic union following fracture increases
with age in humans [24—26]. While young 6-week-old rats
form bone to bridge the fracture gap by 4 weeks after
fracture, adult 26-week-old rats require 10 weeks, and older
52-week-old rats need in excess of 26 weeks [27].
With respect to the effects of increased age on period-
ontal tissues, histological findings such as the following have
been reported: thinning and diminished keratinization of the
epithelium; decreased cell density and synthesized collagen
in periodontal ligaments; and a decreased number of cells on
the osteogenic layer of the alveolar bone [28]. There are
‘natural delays’’ in the healing of older individuals. Open
wounds contract more slowly and incised wounds gain
strength more slowly. Experimental studies indicate that
cellular proliferation, wound metabolism, and collagen
remodeling occur later in older animals. Clinical studies
show, however, that operations can be performed safely in
elderly patients and that the major increased risk to these
patients is of non-wound medical complications that affect
the wound [29]. The ‘‘normal’’ incisional wounds healed
equally well in both groups. On the other hand, the ischemic
wounds in the old animals were found to be impaired by 40—
65% compared to similar wounds in the young animals [30].
Benatti et al. [28] showed that at 3 weeks, aging negatively
influenced density of newly formed bone and percentage of
bone fill in created fenestration defects of rats. At 6 weeks,
aging also negatively influenced density of newly formed
bone, but not percentage of bone fill. They concluded that
aging may impair, but not prevent, periodontal healing.
All of those findings seem to indicate that aging affects the
success of dental implants.
3.2. Pathologic aging
3.2.1. Diabetes
Diabetes mellitus is a significant disorder seen all around the
world. The prevalence of diabetic patients increases with
advancing age, especially in those over 50 and it was three
times greater in females than in males, according to a USA
study, The Third National Health and Nutrition Examination
Survey, 1988—1994 [31].
Diabetic patients show delayed wound healing, frequency
of microvascular disease, impaired response to infection, and
susceptibility to periodontal disease [32], all potentially
complicating factors when placing implants. Also, bone
and mineral metabolism are altered in diabetics [33], pos-
sibly interfering with the integration process [3,32].
Fiorellini et al. [33] in a study of 40 patients found the
survival rate of dental implants in controlled diabetic
patients at approximately 85%. This was lower than that
documented for the general population, but there was still
a reasonable success rate. Morris et al. [34] found in a large
sample population that Type 2 diabetic patients tended to
have more failures than non-diabetic patients; however, the
influence was marginally significant. In addition, Kapur et al.
[35] compared diabetics who had only moderate levels of
metabolic control with non-diabetic patients and also con-
cluded that implants could be used successfully in diabetic
patients.
Moy et al. [6] indicated that even patients with controlled
diabetes were almost three times as likely to develop
implant failure when compared to other patients. Interest-
ingly, Olson et al. [32] found that the implant survival rate
was relatively low in patients with Type 2 diabetes, and
duration of diabetes had an effect on implant success.
Greater failure rates were found in patients who had dia-
betes for longer time periods. The authors theorized that
just as with the increased likelihood of other microvascular
complications, an increasing duration of diabetes could
cause microvascular disturbances that might contribute to
implant complications. Therefore, older patients who have
been diabetic for a longer time are likely to be affected by
implant failure.
Klokkevold and Han [36] concluded in a systematic review
that Type 2 diabetes may have a negative effect on implant
survival, but the limited number of studies available for
review makes this conclusion tentative. In addition, since
the diabetic condition of patients in previous studies was
under control, no comment can be made about implant
survival in patients with uncontrolled diabetes.
3.2.2. Osteoporosis and estrogen status
Osteoporosis is the loss of bone mass and density throughout
the body, including the jaws [37]. Decreased bone mass in
postmenopausal women was reported to involve the alveolar
ridges, similar to other bones in the body [38]. However,
Boyde and Kingsmill [39] stated that common generalizations
about the changes in bone due to aging and osteoporosis are
too simplified, and that the mandible differs sufficiently from
postcranial skeletal sites so that it would be unwise to
extrapolate from findings in the jaw to circumstances else-
where. It is not certain whether bone mass in the mandible
and maxilla parallels bone mass in the rest of the skeleton,
although it has been shown that mandibular bone mineral
content decreases with age and that mandibular bone mass is
lower in elderly female subjects than in male subjects [16].
Slagter et al. [40] found no association between systemic
BMD status, mandibular BMD status, bone quality, and implant
loss. Bone metabolism is impaired and thus, theoretically,
Is old age a risk factor for dental implants? 61
osseous integration may be more difficult to achieve in osteo-
porotic patients; however, established systemic osteoporosis
does not imply that a jaw bone is unsuitable for osseous
integration, nor is it an absolute contraindication to implant
therapy [3]. Becker et al. [41] quantitatively measured osteo-
porotic bone loss in a group of dental implant patients and
found that a simple visual assessment of bone quality at the
site of implant placement may be more informative regarding
implant failure than quantitatively measured osteoporotic
bone loss. No correlation was found between the quantity
of arm bone and implant failures [40]. Osteoporosis frequently
occurs in postmenopausal women, but Dao et al. [9], in study-
ing the association between premenopausal and postmeno-
pausal women and implant failure, did notfind a higher failure
rate for implants placed in women older than 50 years as
compared with women younger than 50 years or between
women and men older than 50 years. Minsk and Polson [42]
also found no correlation in older women with or without
hormonal replacement therapy and implant failures.
None of the aforementioned studies differentiated
between maxillary and mandibular implants. August et al.
[15] examined jaw differences in pre- and postmenopausal
women and found that the effect of postmenopausal estro-
gen status on compromised implant healing was shown in the
maxilla but not in the mandible. The authors found that
postmenopausal women not taking hormone replacements
had the highest failure rate. Although a statistical difference
was not achieved, estrogen replacement therapy reduced
the maxillary failure rate by 41%. The authors reasoned that
because osteoporosis affects trabecular bone more than
cortical bone, and the maxilla has more trabecular bone
composition than the mandible, the maxilla is therefore more
susceptible to the effects of systemic osteoporosis.
It was reported that patients managed by surgeons who
have done more of knee and hip replacement have lower risks
of perioperative adverse events [43,44]. Moy et al. [6],ina
retrospective cohort study on implants done by one very
experienced oral and maxillofacial surgeon, evaluated sys-
temic osteoporosis and its effect on implant failure. The
authors showed that patients who were postmenopausal
and hormone replacement therapy experienced signifi-
cantly increased implant failure. The authors showed
that postmenopausal patients who were taking hormone
replacement therapy experienced significantly increased
implant failure.
4. Quality and quantity of available bone
Bone quality is related to osseointegration, and bone quan-
tity is related to the length of the implant, which is important
for initial stability and longitudinal success [45,46]. As stated
previously, both quality and quantity are theoretically
affected by aging.
Subsequent histomorphometric and microradiographic
studies showed that after the age of 50 there was a marked
increase in the cortical porosity of the mandible, with this
increase being greater in the alveolar bone than the man-
dibular body. With this increase in porosity, there was a
concomitant decrease in bone mass, which appeared to be
more pronounced in females than in males, with the loss in
bone mineral content estimated to be 1.5% per year in
females and 0.9% in males. These studies also demonstrated
a considerable amount of variation in the amounts of cortical
and trabecular bone within and among individuals [47].
Significant or strongly significant differences were found
regarding implant failures as a result of jaw bone quality, jaw
shape, implant length, treatment protocol, and combina-
tions of jaw bone-related characteristics [45]. Approximately
65% of the patients with a combination of the two most
negative bone-related factors (jaw bone quality 4 and jaw
shape D or E) experienced implant failure. Implant length,
the only implant-related factor evaluated, was also signifi-
cantly correlated with the success rate, but implant length
could also be regarded as a result of the jaw bone volume
available. In most cases this was also indirectly or partly
related to the status of the jaw bone available for implant
placement [45].
Morphologically, bone resorption of the labial or buccal
ridge makes prosthetic treatment much more difficult. Hor-
izontal discrepancies between the residual ridge of one jaw
for implantation and the residual teeth or ridge of the other
jaw are common. It is not an age-specific phenomenon, but
occurs frequently in the elderly. Bone quality is of concern
for implant success. To improve our understanding of how
the site-specificity of jaw bone condition affects oral
implant outcomes, research needs to be aimed at establish-
ing reliable and valid measures of preoperative jaw bone
condition, and at better documenting the effects of jaw
bone condition on oral implant outcomes [48].Objective
evaluation of bone quality and quantity with a CT (3-dimen-
sional shape and bone mineral density of local bone), which
has not been established will be important for successful
dental treatment [45].
5. Adaptation and maintenance
As with other prosthetic treatments, adaptation to the pros-
thesis and the ability to maintain it, including having access
to a dental office, are important with dental implant
patients. More problems with adaptation in the elderly
patients could be observed. Elderly patients especially had
more postinstertion problems than those in younger age
groups. Jemt [49] followed 48 patients more than 80 years
old (mean age 82.7 years) who had received a total of 254
implants and found that most had minimal postplacement
problems, similar to what has been observed in younger
patients. However, some patients (10%) experienced obvious
problems with general adaptation and muscle control, which
has not been observed in younger patients. Oral hygiene
problems and associated soft tissue inflammation (mucositis)
as well as tongue, lip, and cheek biting were observed
significantly more often among the elderly patients [7].
6. Problems and limitations in clinical
studies
Study design remains important. Retrospective cohort stu-
dies are easier to complete but due to problems of selection
bias and confounding have less validity than randomized
prospective clinical trials. The conclusions that can be drawn
from retrospective studies may be limited [50]. In such
studies, successful patients and treatment plans tend to
be influenced by ethical considerations so that success rates
62 K. Ikebe et al.
must be relatively high, whether subjects are young or old,
healthy or compromised. We have to realize that if study
samples include all applicants for implant treatment, the
success rate for older patients must be lower than that for
younger ones. Interestingly, Noguerol et al. [46] showed that
in the multiple logistic model, younger age (odds ratio: 4.53),
as well as smoking habits (OR: 2.59), and bone quality (OR:
1.93) were independently related to early failure. This effect
is odd and may be caused by a selection bias, where those
over the age of 60 would only be treated with implants under
‘ideal’ conditions or might, as past users of removable
prostheses, value and take greater care of their new fixed
prostheses.
Clinicians need the results of randomized, controlled
clinical trials for evidence-based decision making. However,
these types of studies are difficult to design and are time-
consuming, expensive and possibly unethical [3].
7. Conclusion
In dental implant treatment, chronological age by itself is
suggested as one of the risk factors for success, but it would
not be a contraindication. In general, reserved capacity of
bone and soft tissue make it possible to establish osseointe-
gration in the long run. Rather than aging itself, the specific
nature of the disease process, such as osteoporosis or dia-
betes, and local bone quality and quantity at the implant
site, mostly related to aging, are more important for success-
ful dental implant treatment.
This review revealed a shortage of published data for the
survival and success of dental implants in older patients.
More studies useful for evidence-based decision making are
needed to assess the survival and success of dental implants
for aged patients with a compromised condition. Long-term
studies are expected to be more revealing of the influence of
risk factors related to aging.
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64 K. Ikebe et al.
... While aging in itself does not preclude the clinician from restoring a patient's dentition with implants, it does present some challenges that are worthy of consideration. As a prognostic factor in implant success, age has been discussed by several researchers [9,15,16]. Older patients potentially have longer healing times, more systemic health factors, and the likelihood of poorer local bone conditions [17] Clinical human studies on delayed bone healing with increased age have attributed a reduction in the number of osteogenic stem cells, reduced proliferation and differential potentials, and reduced local and systemic blood flow. The reduction in bone mass density associated with post-menopausal estrogen depletion confounds this problem, especially for women. ...
... By bone quality, bone density is implied. Bone quality is related to osseointegration while bone quantity affects the length of the implant which is important for stability and longitudinal success [15]. Theoretical evidence suggests that bone quantity and quality decline with increasing age. ...
Article
Full-text available
Objective: This systematic review aims to examine the spectrum of research studies including cross-cultural and international studies that have focused on weight and health-related quality of life in children and adolescents. Methods: Following the PRISMA guidelines, studies published in the past 25 years from 1995 until 2020 that pertain to weight and health-related quality of life (HRQoL) in children and adolescents were identified through the use of Pubmed, ScienceDirect, Google Scholar, and PsycInfo databases. Two authors independently conducted a focused analysis and reached a final consensus on which studies to include using specific selection criteria followed by a quality check of the studies, resulting in the final selection of 25 studies. Results: The selected studies particularized the level of impaired quality of life among normal-weight, overweight and obese children and adolescents, and distinctly found that higher participant weight was correlated with a lower HRQoL score. Conclusion: Studies showed a significant negative correlation between weight and HRQoL. Multiple types of prevention and treatment programs are critically needed to provide resources to improve quality of life in overweight and obese children and adolescents.
... Theoretically, as the age progresses, the recovery time of the patients increases, systemic problems occur and bone quality deteriorates. New bone formation rate and volume around the implants decrease with age (Ikebe, 2009). Age is a risk factor for elderly patients (Nandal, 2014). ...
... Theoretically, as the age progresses, the recovery time of the patients increases, systemic problems occur and bone quality deteriorates. New bone formation rate and volume around the implants decrease with age (Ikebe, 2009). Age is a risk factor for elderly patients (Nandal, 2014). ...
... There was also less plaque accumulation on implants, and the peri-implant mucosa showed a stronger response than the gingiva around the teeth in elderly patients [20]. For reimplant survival, oral hygiene, poor local bone quality, poor bone quantity, and the biological mechanism of bone remodeling, which leads to osseointegration, are more important risk factors than age [21]. Therefore, age should be considered a risk factor, not a contraindication. ...
Article
Purpose: The purpose of this study was to evaluate failed implants and reimplantation survival and to identify the relative risk factors for implant re-failure. Methods: Ninety-one dental implants were extracted between 2006 and 2020 at the National Health Insurance Service Ilsan Hospital, including 56 implants in the maxilla and 35 implants in the mandible that were removed from 77 patients. Patient information (e.g., age, sex, and systemic diseases) and surgical information (e.g., the date of surgery and location of the implants and bone grafts) were recorded. If an implant prosthesis was used, prosthesis information was also recorded. Results: In total, 91 first-time failed dental implants in 77 patients were analyzed. Of them, 69 implants in 61 patients received reimplantation after failure. Sixteen patients (22 implants) refused reimplantation or received reimplantation at a different site. Eight of the 69 reimplants failed again. The 1-year survival rate of the 69 reimplants was 89.4%. Age at reimplantation and smoking significantly increased the risk of reimplantation failure. However, a history of taking anti-thrombotic agents showed a statistically significant negative association with reimplantation failure. Of the failed implants, 66% showed early failure and 34% showed late failure of the initial implantation. All 8 re-failed implants showed early failure. Only 3 of these 8 failed reimplants were re-tried and the second reimplants all survived. Conclusions: The total survival rate of implants, which included reimplants and second reimplants was 99.2%, although the survival rate of the initial implantations was 96.3%. Previous failure did not affect the success of the next trial. Reimplantation failure was more strongly affected by patient factors than by implant factors. Therefore, each patient's specific factors need to be meticulously controlled to achieve successful reimplantation.
... It has been frequently debated whether implant failure is associated with age. 6,7 Several studies have concluded that chronological age by itself is not a factor leading to implant failure. [8][9][10] In contrast, Salonen et al 11 Studies that have compared the outcomes of dental-implant treatment between young and old patients have revealed high survival rates existed in both groups. ...
Article
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Background There is a growing interest in factors leading to implant failure in older people as the population aged 65 years or older continues to expand. Purpose We sought to identify differences of results in the implant survival rate and the influence of certain factors on implant failure in the older (≥65 years) and younger (<65 years) patients. Materials and Methods Patients who underwent their first dental‐implant surgery between July 2008 and June 2018 were included. Data on age, sex, smoking habits, medical conditions, implant location, implant size, and the presence and type of bone graft and membrane were collected and analyzed according to age group. Moreover, cumulative survival rates of implants (by Kaplan‐Meier analysis) and hazard ratios (HR) of each factor (using Cox regression analysis with shared frailty) in each group were assessed and results compared between groups. Results A total of 628 implants in 308 patients and 1904 implants in 987 patients in the older and younger groups, respectively, were assessed, with failure rates of 3.9% and 3.4%. Per Kaplan‐Meier analysis, the 11‐year patient‐level cumulative survival rate of implant treatment was 95.3% (95% CI: 0.91‐0.97) in the older and 93.9% (95% CI: 0.88‐0.97) in the younger group. The HR for implant failure of the variables, except diameter of dental implants, were not statistically significant in both groups. Conclusion The outcomes of implant treatment were not considerably different between the age groups.
... Aging is associated with an increased risk of frailty and related diseases, such as sarcopenia, osteoporosis, and cancer. Chronological age is also considered to be one of the risk factors for successful dental implant treatment, while it is unclear whether aging itself could be an important factor, rather than the factors related to aging [1]. Therefore, further research based on sufficient evidence is needed to assess the survival and success of dental implants in elderly patients. ...
Article
Purpose: Impairment of normal bone remodeling affects the successful osseointegration of dental implants. Recently, it has been reported that complement C1q level increases with age and delays wound healing by modulating Wnt signaling. As Wnt signaling is known to play an essential role in bone remodeling, we hypothesized that aging-dependent increases in C1q affect bone remodeling. In this study, we examined whether C1q affects the differentiation of bone-forming osteoblasts and bone-resorbing osteoclasts, and investigated whether C1q could modify cellular signaling, including the Wnt/β-catenin pathway in these cells. Methods: Osteogenic differentiation of MC3T3-E1 cells was assessed using alkaline phosphatase staining. Differentiation of osteoclasts from mouse bone marrow cells was assessed using tartrate-resistant acid phosphatase staining. Activation of canonical Wnt signaling and protein phosphorylation was monitored using Western blotting. Results: C1q, at 5-15 µg/mL promoted osteoclast fusion, whereas it did not affect the differentiation of osteoblasts. On the other hand, a higher concentration of C1q (50 µg/mL) suppressed both bone morphogenetic protein-2-induced osteogenic differentiation and osteoclast formation. C1q did not induce an obvious activation of Wnt/ β-catenin signaling in either pre-osteoblasts or pre-osteoclasts, contrary to previous reports using other tissues. Instead, C1q upregulated the receptor activator of nuclear factor-kappa B ligand (RANKL)-induced phosphorylation of Akt. Conclusions: C1q could affect cellular signaling and modify the differentiation of osteoblasts and osteoclasts, depending on the concentration. Therefore, an increase in C1q with age could be one of the factors that determine the prognosis of treatment of elderly patients.
... 1,4,[6][7][8][9][10][11][12] There are several factors that affect the success of osseointegration, including quality and quantity of the bone, oral hygiene, patientrelated medical risk factors (e.g., systemic diseases or habits such as smoking), implant design, and operator skills. 1,3,[6][7][8][9][11][12][13][14][15][16][17] Nowadays, there are approximately 1,300 different implant systems available that vary in shape, dimension, bulk and surface material, thread design, implant-abutment connection, surface topography, surface chemistry, wettability, and surface modification. The most common implant shapes are cylindrical or tapered. ...
Article
Full-text available
Biological stability greatly influences osseointegration, which ultimately affects the success of implant treatment. Though implant thread design is one important factor influencing implant stability, not many studies have analyzed its impact on biological stability. This experimental study involving 44 implants evaluated the biological stability of threaded implants with cylindrical (bone-level; BL) and tapered (bone-level tapered; BLT) designs. Implant stability was evaluated for each implant at 3 time parameters using resonance frequency analysis. A mean implant stability quotient (ISQ) value was calculated for each measurement time. A significant increase in the ISQ value was found at each time parameter consecutively at the time of implant placement one month and 2 months after implant placement in both implant design groups (P < 0.05). No significant difference was noted in ISQ value between the groups at all 3 time parameters (P = 0.05). There was also no significant difference in the ISQ value at all 3 time parameters between implants with diameters of 4.1 mm and 4.8 mm in the BL and BLT implant groups (P = 0.71). The implant thread designs of BL and BLT implants did not affect the biological stability. Other factor such as implant diameter also did not affect the biological stability in either implant group. Clinical article (J Int Dent Med Res 2020; 13(3): 1065-1070)
... this result agrees with investigators associating aging with lower bone quality and quantity and chronological age by itself was suggested as one of the risk factor for implant success but not as a contraindication. 22 Intraoral location revealed a significant effect on primary implant stability whereby implants placed in the posterior mandibular sites were seen to have higher primary implant stabil- ...
Article
Full-text available
Background: The aims of this study were to enumerate the primary implant stability quotient (ISQ) value of self-tapping dual etched implants and to explore the influence of parameters such as implant length, implant diameter, age, gender, implant location and osteotomy preparation on the ISQ value. Methods: Retrospective data from clinical worksheets given to participants during two implant courses held between the periods of 2013 to 2014 were evaluated. A total of 61 implants were considered based on the inclusion criteria. The effects of parameters such as implant diameter, implant length, age, gender, implant location and osteotomy protocol on ISQ values were analyzed. Results: Mean ISQ value for all implants was 67.21±9.13. Age of patients (P=0.016) and location of implants (P=0.041) had a significant linear relationship with the ISQ values. Within the age limit of the patients in this study, it was found that an increase in one year of patient's age results in 0.20 decrease in ISQ value (95% CI: -0.36, -0.04). However, placing an implant in the posterior maxilla may negatively affect the ISQ with a likely decrease in primary stability by 6.76 ISQ value (95% CI: -13.22, -0.30). Conclusions: The results suggest that the mean ISQ achieved by the participants were comparable with the range reported for this particular type of implants. The patient's age and location of implants were elucidated as the determinant factors of primary implant stability.
Article
This study aimed to estimate and compare the clinical, radiographic, and restorative parameters around short tuberosity implants (STIs) placed in cigarette smokers (CS) and never smokers (NS). In this 60-month follow-up retrospective study, a total of 50 (37 males + 13 females) individuals who had received 82 dental implants were included. These participants were categorized into two groups as follows: (i) Group-1: 25 self-reported systemically healthy CS with 43 STIs; and (ii) Group-2: 25 self-reported systemically healthy NS with 39 STIs. In both groups, peri-implant plaque index (PI), probing depth (PD), bleeding on probing (BOP), and crestal bone loss (CBL) and restorative parameters were measured at 12 and 60 months of follow-up. Group comparisons were performed utilizing the Kruskal–Wallis test. The significance level was set at p < 0.05. In CS and NS, the mean age of participants was 58.5 and 60.7 years, respectively. No statistically significant differences were observed in the overall mean levels of PD and CBL around STIs among CS and NS. However, a statistically significant increase was observed in the mean scores of BOP and PI around STIs in the NS and CS at 12 and 60 months follow-up, respectively. In both groups, the loosening of the implant was the most frequently encountered type of STI failure. The outcomes of the present study suggest that STIs placed in maxillary tuberosity can show reliable clinical, radiographic, and restorative stability among cigarettes smokers and non-smokers. However, the role of smoking status and oral hygiene cannot be disregarded in this scenario.
Article
Wound healing is a fundamental survival mechanism, largely taken for granted. It consists of four intricately tuned phases: haemostasis, inflammation, proliferation and remodelling. Successful wound healing only occurs if each phase occurs in the correct sequence and timeframe. Moreover, the oral cavity serves as a unique and remarkable setting whereby wound healing takes place in a saliva-filled environment containing millions of micro-organisms. Many local and systemic factors can impair oral wound healing. This article provides an overview of the wound healing process, with a discussion of these respective local and systemic factors, along with the potential cellular and/or molecular mechanisms involved. CPD/Clinical Relevance: On a daily basis, dentists perform procedures such as exodontia and implant placement that rely on adequate wound healing. An improved understanding of the local and systemic factors that can impair oral wound healing can help clinicians to control these factors more accurately, resulting in improved patient outcomes.
Article
This literature review summarizes research with the aim of providing dentists with evidence-based guidelines to apply when planning treatment with osseointegrated implants. Peer-reviewed literature published in the English language between 1969 and 2003 was reviewed using Medline and hand searches. Topics reviewed include systemic host factors such as age, gender, various medical conditions, and patient habits, local host factors involving the quantity and quality of bone and soft tissue, presence of present or past infection and occlusion, prosthetic design factors, including the number and arrangement of implants, size and coatings of implants, cantilevers and connections to natural teeth, and methods to improve outcomes of implant treatment in each category. The review demonstrated that there is no systemic factor or habit that is an absolute contraindication to the placement of osseointegrated implants in the adult patient, although cessation of smoking can improve outcome significantly. The most important local patient factor for successful treatment is the quality and quantity of bone available at the implant site. Specific design criteria are provided, including guidelines for spacing of implants, size, materials, occlusion, and fit. Limitations in the current body of knowledge are identified, and directions for future research are suggested.
Article
Although it has been accepted that osteoporosis is common in women, only recently have we become aware that it is also widespread in men; one in twelve men in the UK have osteoporosis. In many cases, there are recognisable causes for their osteoporosis, but a significant proportion (approximately one third) of these men have idiopathic disease. A major problem is that these cases are difficult to treat. An important therapeutic strategy would be to identify men at risk from osteoporosis sufficiently early, so that they can begin preventative measures. Moreover, development of novel means of treating these men would be an important clinical advance. With the emphasis on osteoporosis in women, however, the cellular and molecular basis for male idiopathic osteoporosis (MIO) is still poorly understood. Nevertheless, there are some aspects of skeletal regulation which may be specific for men and which could form the basis for addressing these problems. Thus, the importance of oestrogen in maintaining the adult skeleton in men as well as women implies that bone cells in men can respond to low levels of the hormone. Both oestrogen receptor (ER) alpha and beta are expressed in bone in vivo, which may be important for oestrogen action on bone in men. Furthermore, in osteoporosis generally, there is increasing evidence for defective osteoblast differentiation such that there is a surfeit of adipocytes over osteoblasts. A low peak bone mass is a powerful risk factor for osteoporosis in later life; bone formation and, by implication, osteoblast differentiation, is key to the mechanism by which it is accrued. GH and IGFs are important for regulating osteoblast differentiation. Evidence now suggests that they are associated with bone mineral density, particularly in men. The genes for ERs, GH and IGF-I might be useful candidates with which we can begin to detect men at risk from osteoporosis. Furthermore, the mechanisms by which oestrogen, GH and IGF-I regulate the male skeleton could provide the basis for developing novel means of treating MIO.
Article
Implant prognoses for healthy elderly patients have been found to be comparable with those reported for younger patients. In 1991, the Dental Implant Clinical Research Group initiated a prospective, randomized clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on long-term clinical performance and crestal bone height. As a result of the large sample size and wide range of patient ages, the study provided an opportunity to determine if age correlates with implant survival. Interim analysis of 2,132 root form implants at uncovering on an implant, case, and patient basis suggests that implant survival does not appear to be influenced by age in the largely white, male sample. (Implant Dent 1994;3:247-251)
Article
There are "natural delays" in the healing of older individuals. Open wounds contract more slowly and incised wounds gain strength more slowly. Experimental studies indicate that cellular proliferation, wound metabolism, and collagen remodeling occur later in old animals. Clinical studies show, however, that operations can be performed safely in elderly patients and that the major increased risk to these patients is of nonwound medical complications that affect the wound.
Article
Experimental studies have not shown that the 'common' clinical experience, which suggests that wound healing is impaired in an old organism, is valid for healthy old experimental animals. We have developed a model in the rat for ischemic wound healing by using an H-shaped double skin flap, where the test wound is the horizontal line in the H. Our previous studies have shown that the blood flow in this wound is only 7% of that of a normally vascularized wound on the first postoperative day. Functional (biomechanical) properties of this wound are decreased by up to 67% after 10 days of healing and certain key properties by up to 64% after both 10 and 20 days. This study reports on the effect of aging, using 3- and 24-month-old rats. The 'normal' incisional wounds healed equally well in both groups. On the other hand, the ischemic wounds in the old animals were found to be impaired by 40-65% compared to similar wounds in the young animals. It is concluded that ischemia is deleterious for wound healing in old age and that one of the key elements of the clinical experience of impaired wound healing in old age is probably based on concomitant diseases in old patients, contributing to varying degrees of ischemia in the traumatized tissue.
Article
Clinical experience suggests that severe alveolar bone resorption can limit the success of complete denture wearing. The loss of bone mineral with age occurs throughout the skeleton, which contributes to the high incidence of bone fractures later in life. Women are more commonly affected by some of these fractures. The decline in serum oestrogen concentration following the menopause has been implicated in the aetiology of these fractures. We have found that age is important in determining the bone resorption observed in females but not in males.
Article
After exclusion of delayed unions and pseudoarthroses in teenagers, the time required for union of 275 consecutive fractures of the femoral diaphysis in children followed a log-normal pattern with a constant 10 percent coefficient of variation and a geometric mean increasing uniformly by 0.7 weeks per year. Multiple injuries increased, and operative treatment reduced the geometric mean time for fracture healing. © 1988 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.