January 1, 2004
by Milan Somborac DDS
The aging of North Americans has attracted the attention of many interest groups. Sports equipment manufacturers have increased their production of golf clubs and decreased their production of tennis rackets. Automobile manufacturers have increased the font size of dashboard instrument displays. The pharmaceutical industry has brought us Viagra. Examples abound.
Neurocognitive impairment is a prominent feature of aging. Associated with it is a decrease in oral hygiene. Coupled with common drug-induced xerostomia the risk for caries in individuals 70-years-of-age and older is increasing even as it is decreasing in children and in adults up to age 40. Millions of North Americans are affected.
Dental care providers need to be aware of the unique problems associated with the treatment of older patients. Will the traditional conservative therapies serve these patients well? Are the newer implant modalities better suited for resolving their problems? The well-documented, long-term success of implant treatment requires us to consider it as an option for selected cases of decay.
Three such cases follow. They show the implant solution to rampant decay in the elderly.
A 72-year-old male with rampant decay affecting his remaining nine mandibular teeth presented for treatment. He had an adequate full upper denture. He had Parkinson’s disease, smoked 25 cigarettes daily for many years and was a moderate drinker.
He was informed that the prognosis for the remaining mandibular teeth was poor. Retaining some of his remaining teeth for overdenture retention after endodontic and prosthetic treatment was explained, as was the significant risk of recurrent decay.
He was also told that the dental literature now supports immediate implant placement and that there would be no surgical trauma additional to that of the extraction surgery.
Implant overdenture retention for him would be more predictable in the long term. He agreed to accept immediate implant placement.
Using oral sedation, anti-inflammatory and antibiotic premedication and local anesthesia, all mandibular teeth were removed, interseptal bone was harvested, morcelised and placed into osseous defects resulting from the extractions. Implants were placed in sites with the maximum bone height and width while ensuring spacing between implants for overdenture retention.
An immediate denture was inserted after relieving the acrylic over the implants to minimize the risk of overload. It was placed primarily for cosmetic reasons. Ten weeks later, overdenture abutments were cemented into the implants and the immediate denture was modified to connect to them. The patient has enjoyed problem-free function since.
Mandibular treatment and results for the other two cases shown are similar. Dentists see similar cases of rampant decay frequently. Is conventional treatment really the answer for these patients? Shouldn’t they know about the implant solution?
Tenax Dental Implant System implants were used in all cases illustrated in this article. Dr. Somborac is in private practice and is a shareholder in Tenax Implant Inc. Oral Health welcomes this original article.