stomaeduj-2-2020-article-3
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ORAL IMPLANTOLOGY
IS THERE AN AGE LIMIT FOR IMPLANT DENTISTRY?
Original Articles
Daya Masri1,5a* , Liat Chaushu2b , Joseph Nissan3c , Sarit Adriana Naishlos4d , Gavriel Chaushu1,5e
1
Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tiqwa, Israel
2
Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
3
Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
4
Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
5
Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
a
DMD; e-mail: dr.dayamasri@gmail.com; ORCIDiD: https://orcid.org/0000-0002-3808-8664
b
DMD, MSc; e-mail: liat.natanel@gmail.com; ORCIDiD: https://orcid.org/0000-0002-5755-7526
c
DMD, MSc; e-mail: nissandr@gmail.com; ORCIDiD: https://orcid.org/0000-0001-7290-4357
d
DMD; e-mail: river554@gmail.com; ORCIDiD: https://orcid.org/0000-0002-2920-7000
e
DMD; e-mail: gabi.chaushu@gmail.com; ORCIDiD: https://orcid.org/0000-0001-9176-4978
ABSTRACT https://doi.org/10.25241/stomaeduj.2020.7(2).art.3
Introduction Aging may impede implant survival due to compromised wound healing. The present study
assessed, retrospectively, whether there is an age limit for implant dentistry.
Methodology All patients treated with a single implant brand in a single medical center were included. Early
implant failure (EIF) was recorded. The cohort was divided to a younger (20 to 65) and an older (≥65) group.
The comparison between groups was based on: (1) gender (2) physical status (3) implant location (4) implant
dimensions (5) number of implants placed per patient and (6) bone grafting.
Results Out of 121 patients, the younger group comprised 57 and the older 64. The younger cohort received
192 implants (mean: 3.25±3.68, range: 1 to 16 implants per patient) vs. 171 (mean 2.78±1.91, range: 1 to 11
implants per patient) in the older group. The older did not differ significantly (p > 0.05) from the younger
in any of the parameters evaluated. EIF on implant and patient level was 1.0 and 3.5%, respectively in the
younger vs. 1.1 and 3.1%, respectively in the older. Seven patients were ≥80 years. EIF at implant and patient
level was 8.3 %and 14.3% respectively.
Conclusions Elderly patients ≥65 years old presented a similarly low EIF rate as younger patients 20 to 65
years old, while patients ≥80 years old may have a slight tendency for a higher EIF rate. Hence, there seems
to be no age limit for implant dentistry.
KEYWORDS
Early Implant Failure; Osseointegration; Older Population; Dental Implant; Aging.
1. INTRODUCTION suggested that age may be associated with a higher
implant failure rate [8,9]. Bone quality and quantity
The growing numbers of population ≥ 65 years [1] are related to initial stability and longitudinal
offer an important challenge for the dental profes- success [10,11]. Both are theoretically compromised
sion. Implant dentistry has a major contribution to by aging. After the age of 50 a marked increase in
improving life quality [2-4]. Aging may compromise bone porosity and decrease in bone mass, were
implant survival due to compromised wound healing demonstrated [12]. Implant success can thus be
[5,6]. The proliferative phase of healing is prolonged compromised [10]. Bone volume may be reduced
due to reduced numbers of stem cells [6]. A study in requiring grafting before or with implant placement.
a rat model demonstrated that the younger group Bone augmentation success is age-related [13]. The
achieved good bone contact faster than the older decrease in the number of pluripotent cells within
one. The results suggested that the rate and volume the bone marrow [14,15] and the reduced numbers
of new bone formation around implants decrease of osteogenic cells at recipient sites combined with
with age [7]. Other studies on implant treatment low vascularity [16] are suggested factors that might
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Masri D, Chaushu L, Nissan J, Naishlos SA, Chaushu G. Is there an age limit for implant dentistry? Stoma Edu J. 2020;7(2):102-107.
Received: May 05, 2020; Revised: May 13, 2020; Accepted: May 15, 2020; Published: May 18, 2020
*Corresponding author: Dr. Daya Masri, DMD, Department of Oral and Maxillofacial Surgery, Rabin Medical Center-Beilinson campus, Petah Tikva, Israel;
Department of Oral & Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
Tel.:+972-528836333; Fax:+972-37715001; e-mail: dr.dayamasri@gmail.com
Copyright: © 2020 the Editorial Council for the Stomatology Edu Journal.
102 Stoma Edu J. 2020;7(2): 102-107 pISSN 2360-2406; eISSN 2502-0285
Age limit for implant dentistry
Fig. 1 Patient distribution according to age
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extracted and manually screened twice by 2
Original Articles
Age distribution examiners (DM and GC).
Inclusion criteria – Complete documentation; mini-
mum follow-up – 12 months following prosthetic
16% 11% delivery.
20-40 13% Exclusion criteria – history of head and neck cancer and/
41-55 15% or immune deficiency due to immunosuppressant
56-65
medication, uncontrolled systemic diseases, heavy
66-70 24%
71-75
21% smokers, untreated periodontal disease.
76-91 The following parameters were recorded:
m age
m gender
m physical status according to American Society for
Anesthesiology (ASA)
Figure 1. Patient distribution according to age.
m implant location
m implant dimensions (length, diameter)
compromise bone grafting in the elderly. Implant m bone augmentation prior to or simultaneously
failures can be divided into early and late [17] with implant installation (yes/no)
according to timing of failure - abutment connection m number of implants placed
[18,19]; loading [20]; several weeks after placement m early implant failure (EIF) – lack of osseointegration
of the final prosthesis [21]; 12 months after loading up to 12 months after prosthesis delivery and
[22,23]. Late failures are associated with moderate to occlusal loading (yes/no; primary outcome variable).
severe bone loss, a larger number of failed implants
per patient, a higher incidence in men, and mostly 2.2. Statistical Analysis
in posterior areas. Early failures are associated with The descriptive statistics were calculated for patient-
minimal bone loss, occur more in women, and in and implant-related characteristics. The cohort was
most cases the implants were intended to support classified into 2 age sub-cohorts: (1) 20-65 years old at
single crowns [17]. There are studies indicating that time-point of implant installation) and (2) ≥ 66 years
increasing age alone is not a contraindication for old at time-point of implant installation. The Fishers’
implant treatment [24-28]. However, there is still lack exact test or chi-squared test was used to assess any
of information on early implant failure (EIF) in the potential differences regarding the various categorial
elderly (implant loss up to 12 months post loading). parameters (gender; ASA status; implant location;
Therefore, the aim of the present study was to assess, implant dimensions; bone augmentation; number
retrospectively, EIF rate in an older (≥ 66 years old) of implants placed; number of EIF). Patient specific
patient cohort up to one year after prosthetic parameters have been compared at patient level,
delivery, and to compare it with a younger (20 to 65 while implant specific parameters at implant level.
years old at time-point of implant installation) one. A statistical analysis was performed using SPSS
Version 24.0 (SPSS Inc., Chicago, IL, USA) and p-values
2. MATERIALS AND METHODS < 0.05 were considered as statistically significant.
The present retrospective, cohort study is based 3. RESULTS
on dental records of the Department of Oral and
Maxillofacial Surgery, Rabin Medical Center, Campus 3.1. Patient population
Beillinson, Israel, which were selected automatically Most of the patients were between 56-70 years old
(electronically) based on information from the den- (45%) (Fig. 1). Out of 121 patients, the younger group
tal implant records, from 01/2017–12/2018. All treat- comprised 57 and the older 64. Mean age was: 50.5
ments were performed by experienced oral and ± 0.53 years (range: 20-65 years; 61.4% females) vs.
maxillofacial surgeons and the only implant type 73.1±5.65 years (range: 66-91 years; 65.6% females)
installed was molecular precision implant (MPI™), respectively.
endosseous, conical, sand-blasted and acid-etched
surfacing (Ditron Dental, Ashkelon, Israel). The study 3.2. ASA status
protocol was approved by the ethics committee of All patients had physical status either I or II. No statis-
the Rabin Medical Center, Campus Beilinson, Israel tically significant differences between the groups
(0674-19rmc). The present manuscript complies with (p>0.05).
the STROBE guidelines.
3.3. Implant data
2.1. Patient population The younger patient cohort received 192 implants
The dental records of all patients who had received (mean: 3.25±3.68, range: 1 to 16 implants per
an MPI™- (Ditron Dental, Ashkelon, Israel). Dental patient) vs. 171 (mean 2.78±1.91, range: 1 to 11
implant between 01/2017 and 12/2018, were implants per patient) in the older group. Data on
Stoma Edu J. 2020;7(2): 102-107 pISSN 2360-2406; eISSN 2502-0285 103
Masri D, et al.
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Original Articles Table 1. Implant number and dimensions (diameter & length) according to location.
Diameter (mm) Length (mm)
Number Mean Min. Max. Median Mean Min. Max. Median
Maxilla 163
Anterior Young 33 3.70 3.3 3.75 3.75 11.90 8 13 11.5
Old 32 3.83 3.3 4.2 3.75 11.97 10 13 13
Premolar Young 34 3.86 3.75 4.2 3.75 11.67 8 13 11.5
Old 21 3.85 3.75 5 3.75 12.40 8 13 13
Molar Young 24 4.18 3.75 5 4.2 11.375 8 13 11.5
Old 19 4.16 3.75 5 4.2 11.5 10 13 11.5
Mandible 200
Anterior Young 35 3.76 3.75 5 3.75 11.56 10 13 11.5
Old 38 3.74 3.3 4.2 3.75 11.32 8 16 11.5
Premolar Young 37 3.71 3.3 4.2 3.75 9.97 8 13 10
Old 34 3.74 3.3 4.2 3.75 10.15 8 13 10
Molar Young 29 3.98 3.3 5 3.75 9.29 6 11.5 10
Old 27 3.99 3.3 5 3.75 9.26 8 11.5 10
implant locations- number of implants per jaw area no significant differences of implant survival (94
and implant dimensions (length and diameter) per vs. 95%, respectively) [30]. The failure of osseo-
area are presented in Table 1. The older group did integration was suggested as the main reason for
not differ significantly (p>0.05) from the younger EIF [31]. Contributing factors may be patient-related
group in any of the parameters. Bone grafting was [18,19], surgeon-related [22], and biomaterial-
performed in 14/57 (24.6%) of the patients in the related [32].
younger group vs. 18/64 (28.1%) of the older group. These studies used many implant systems with
Mean follow-up was 27.3±8.4 months in the younger different designs, which could have greatly affected
group vs. 24.9±6.2 months on the older one. the results. Consequently, we concentrated on a
single implant from a single implant system in the
3.4. Early Implant Failure (EIF) present study. The group comparison accounted for
In the younger patient group, 2 patients had one 5 factors, i.e., gender, ASA status, jaw site, implant
EIF each. EIF on implant and patient level was 1.0 characteristics (number and dimensions), and need
and 3.5%, respectively. In the older patient group 2 of bone grafting, while some other factors were
patients had one EIF each. EIF on implant and patient controlled through inclusion criteria - choosing the
level was 1.1 and 3.1%, respectively. same type of implant (i.e., MPI / Ditron™ Dental) and
implant insertion by experienced oral and maxillo-
3.5. Patients ≥80 years old facial surgeons.
A special attention was given to 7 patients (3 females A review points out 65 years of age has been as the
and 4 males) ≥80 years old (Table 2). A total of 12 cut-off to define "older" in several studies [29]. That
implants were placed (1-3 per patient). The locations is the reason for choosing this age as cut-off in the
varied. Bone augmentation was not performed in present study. The age of 7 patients was ≥ 80 years
any of the cases. One implant failed in the oldest old, contributing 12 implants. Bone augmentation
patient (91 years old). EIF at implant and patient level was not performed in any of those patients and the
was 8.3 % and 14.3% respectively. We speculated number of implants did not exceed 3 implants.
that the extremely poor-quality soft bone of the Those facts emphasize the desire to keep implant
posterior maxilla could be the failing reason. dentistry at age ≥ 80 years simple and with minimum
potential morbidity. EIF at implant and patient level
4. DISCUSSION was 8.3 % and 14.3%, compared with the entire older
(≥66 years old) patient group, in the present study,
In the present study EIF were not more frequent which resulted in EIF of 1.1% and 3.1%, respectively.
in older (≥ 65 years old) vs. younger patients (20- Nevertheless, it should not be forgotten that these
55 years old), and in general rare (around 1% on fractions still represent only one EIF case. This EIF
implant and between 3 to 4% at patient level). This is compatible with previously reported risk factors
corresponds with the existing literature on implant for EIF – women and implants intended to support
therapy in the elderly. A review on implants in older single crowns [17]. Correspondingly, other studies
patients reported implant survival rates of 98% at reported higher EIF in patients ≥ 80 years old [33,
1 year and 91% at 10 years [29]. Another review on 34]. Specifically, 4.5% at implant level [33], or 9.7% at
implant failure in older vs. younger patients, reported patient level [34]. Still, 6/7 patients aged ≥ 80 years
104 Stoma Edu J. 2020;7(2): 102-107 pISSN 2360-2406; eISSN 2502-0285
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Original Articles
Table 2. Implant characteristics for patients ≥80 years old.
Age (years) 80 80 80 83 84 90 91
Gender Female Male Male Male Female Male Female
Number of
1 1 1 2 3 2 2
implants
Follow up (months) 20 28 22 24 38 23 26
Location 27 23 21 35 42 42 15
1st Implant
Dimensions 4.2/ 3.75/ 3.75/ 4.2/ 3.75/ 3.75/ 3.75/
(mm) 13 11.5 13 11.5 10 11.5 11.5
Location 41 43 43 26
2nd implant
Dimensions 4.2/ 3.75/ 4.2/ 3.3/
(mm) 11.5 10 11.5 11.5
Location 44
3rd implant
Dimensions 3.75/
(mm) 10
Bone
No No No No No No No
augmentation
Failure No No No No No No 1
old in the present study showed successful primary CONFLICT OF INTEREST
osseointegration and received final prosthetic resto-
The authors declare no conflict of interest.
ration.
Considering the limitations that the present study is AUTHOR CONTRIBUTIONS
retrospective, the physical status of both elderly and
younger patient groups was good, the operators DM: conception and design of the study, acquisition of data,
were experienced oral and maxillofacial surgeons, analysis and interpretation of data, drafting the article, final
and only few EIF were observed, it is still reasonable approval of the version to be submitted; LC: conception and
to conclude, that there is no age limit for implant design of the study, analysis and interpretation of data, drafting
dentistry. the article, final approval of the version to be submitted; JN:
conception and design of the study, analysis and interpretation
5. CONCLUSIONS of data, drafting the article, final approval of the version to be
submitted; SAN: conception and design of the study, analysis and
Elderly patients ≥65 years old presented a similarly interpretation of data, drafting the article, final approval of the
low EIF rate as younger patients 20 to 65 years old, version to be submitted; GC: conception and design of the study,
while patients ≥80 years old may have a slight ten- acquisition of data, analysis and interpretation of data, drafting
dency for a higher EIF rate. Hence, there seems to be the article, final approval of the version to be submitted.
no age limit for implant dentistry.
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Daya MASRI
DMD
Department of Oral and Maxillofacial Surgery
Rabin Medical Center- Beilinson Campus, Petah Tikva, Israel
Department of Oral and Maxillofacial Surgery
The Maurice and Gabriela Goldschleger School of Dental Medicine
Tel Aviv-University, Tel Aviv, Israel
CV
He graduated from the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. He is
chief resident at the Department of Oral and Maxillofacial Surgery in Rabin Medical Center- Beilinson Campus. He is a member
of the Israeli Society of Oral & Maxillofacial Surgery, and also a member of the Israeli Dental Association. He lectures nationally
and internationally. His private practice is in Tira, Israel.
106 Stoma Edu J. 2020;7(2): 102-107 pISSN 2360-2406; eISSN 2502-0285
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Questions
Original Articles
1. Timing of early implant failure in the present study?
qa. At surgery;
qb. At 2nd stage surgery;
qc. Up to one year after loading;
qd. Up to 6 weeks after loading.
2. EIF rate for patients ≥80 years old?
qa. Was similar to younger group;
qb. Was similar to older group;
qc. Had a slight higher tendency;
qd. Was better than younger group.
3. The main wound healing problem in the older?
qa. Lack of myofibroblasts;
qb. Reduced numbers of stem cells;
qc. Lack of osseointegration;
qd. Lack of ossification.
4. Implant dimensions in the older were?
qa. Similar;
qb. Higher;
qc. Lower;
qd. Not recorded.
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