Clinical Aspects of Implant Application for Treatment of Elderly Persons

Lungu Valeriy, Associate Professor, Candidate of Medicine, the Odessa National Medical University, Oral Surgery Chair. Ukraine

Introduction

The orthopedic treatment is much in demand of elderly persons. The risk factors inherent in this group of patients include accumulation of general diseases such as cardiovascular impairments, metabolic disturbances, degenerative and mental disorders. Application of bone augmentation techniques entails substantial prolongation of treatment period failing to meet the requirements of such patient. Successful treatment of patients with symptomatic atrophy of the maxillae is assured at the expense of short (5 – 7 mm long) implants being applied and/or inclined insertion of long implants through tuberosity of maxilla to connection with cuneiform bone.The object of this work lay in analysis of frequency of implant application when atrophy of maxillary alveolar processes without application of bone augmentation techniques.

Materials and Methods of Study

The group under study consisted of 24 patients being proposed and subjected to treatment of maxillary defects of dentitions with the prosthesis supported by Alpha Dent Implants in the area of atrophied bone tissue. The age range of patients was within the bounds from 57 to 87; the periods of removable denture wearing varied from 1 to 15 years. The supervision has been lasting since 2008 till now. The most height of alveolar crest (down to the bottom of antrum of Highmore) equaled to 1 – 7 mm according to radiographic data. A long implant being from 13 to 18 mm high or a short one being 5 – 7 mm high were inserted into the raphe joining the tuberosity of maxilla and pterygoid processes of basal bone in the area of tuberosity of maxilla if the attached gingiva was available (Photo 3).


Photo 1. Atrophy of alveolar processes in elderly people	Photo 2. Roentgenogram of a patient from the group under study	Photo 3. Short implant being 5 mm long

Results of Study and their Discussion

The bone remodeling process after tooth extraction leads to alveolar crest atrophy. This results in appearance of areas with very thin bone in the lateral portions of elderly people’s maxillae (Photo 4). The elderly people’s readiness for continuous care is decreasing because this population group correlates the duration of care with their supposed life span. The associated damage (duration, high prices and risk of poor results) fails to meet the patient’s requirements. The atrophy of alveolar process caused by loss of teeth fails to entail atrophy of pterygoid processes of basal bone (Photo 5).

It is universally recognized that occlusive forces should be redistributed to opposite cortical plates, and this fact has roused us to insertion of tubercular-pterygoid implants. The implant is fixed through the tuberosity of maxilla to maxillary-basal raphe bypassing the sinus (Photo 6). Insertion of short implants but only in the area of tuberosity of maxilla may be considered as the alternative to the procedure aforementioned (Photo 7).


Photo 4.The areas with very thin bone are observed in the lateral portions of elderly people’s maxillae.	Photo 5.The atrophy of alveolar process caused by loss of teeth fails to entail atrophy of pterygoid processes of basal bone.	Photo 6a.The implant is fixed through the tuberosity of maxilla to maxillary-basal raphe bypassing the sinus.


Photo 6b.	Photo 7.Insertion of short implants in the area of tuberosity of maxilla.

The analysis of own clinical experience being carried out as well as analysis of maxillary roentgenograms makes it possible to assert the following:

1. There are no any absolute age contraindications for insertion of implants.

2. Insertion of long or short Alpha Dent Implants into the areas with the minimum height of alveolar crest makes it possible not only to avoid supplementary financial expenditure and additional injuring when augmentation of bone tissue but substantial shortening of the terms of treatment.

3. The results of treatment obtained by us meet the requirements made by elderly people to fixed dental prosthetics on the implants (Photo 9).


Photo 8.The gingiva former has been placed.	Photo 9.The results of treatment obtained by us meet the requirements made by elderly people to fixed dental prosthetics on the implants.

Clinical Aspects of Implant Application for Treatment of Elderly Persons