Update in clinical procedures

Identifying the best treatment option

Over the past few decades, the global population’s average age is rapidly increasing. One of the consequences of this ageing demographic is a continued high prevalence of edentulism.

Being edentulous

Edentulism is associated with a number of health problems: poorer nutrition, higher morbidity and earlier mortality, along with greater risk of cognitive disorders and dementia (Batty et al., 2013). The author stated that these problems are accompanied by higher medical expenses that can be correlated with the number of remaining teeth: the fewer teeth are left, the higher the medical bill. Edentulism also influences patients’ eating habits and their lifestyle.

What do elderly, edentulous patients think of dental prostheses and implant treatment?

The things that elderly patients value the most in their conventional dentures are: the ability to eat and talk; comfort and stability; and aesthetics. As for implant treatment, what worries them most is: cost, pain, and potential complications. Elderly patients tend to have a feeling of ‘fragility’ regarding implant treatment. In fact, there are a number of elderly patients who do not want to have implants, even though they may improve their situation. This topic is covered in the ‘Refuser Study’ (Ellis 2011).

Many of these patients are not happy with their existing conventional dentures. However, over the years, they began to feel more vulnerable or that their gums and bones are too weak, and that implant treatment brings more risks than benefits. In these cases, practitioners should carefully explain the suggested procedures and their benefits to try to assuage their fears.

Mandibular implant-supported prostheses. Think they’re all the same?

A study was carried out to evaluate the quality of life in patients treated with either fixed or removable prostheses on 4–6 implants (de Grandmont et al., 1994). No significant differences were found in terms of overall satisfaction, ability to eat/speak and aesthetics (regardless of whether the prosthesis was fixed or was a bar overdenture). Patients reported that the fixed prostheses were more stable, allowing better eating, but the removable one was more aesthetic and easier to clean (Feine et al., 1994).

However, there are significant differences in the aforementioned indicators between lower overdentures on two implants and conventional complete prostheses (Thomason 2003). Prostheses on two implants usually experience some degree of rotation, which can affect the patient’s function. To this end, two factors must be taken into account: the height of the alveolar flange; and the position of the incisors with respect to the alveolar flange. The more anterior the incisors are positioned (with respect to the flange), the more rotation there is (Kimoto et al., 2009).

There are numerous clinical studies involving narrow-diameter implants (<3 mm) supporting lower overdentures. These studies show that narrow implants can behave the same way as those with conventional diameters. Other studies have shown that the quality of life and satisfaction levels of patients with lower overdentures on one conventional diameter implant is similar to those with overdentures on two implants. The speaker concluded with a general rule for treating older patients: the poorer their overall health, the simpler the treatment should be.