Fixed Implant‐Supported Prostheses in Elderly Patients: A 5‐Year Retrospective Comparison between Partially and Completely Edentulous Patients Aged 80 Years or Older at Implant Surgery

Background: Knowledge on implant treatment in the partially edentulous patient is low for elderly patients aged 80 years or older at inclusion. Purpose: The objective of this study was to report and compare the clinical and radiological performance of implant treatment in edentulous and partially edentulous elderly patients during 5 years in function. Material and Methods: Altogether, 192 edentulous (control) and 72 partially edentulous (study) patients, consecutively treated and provided with 1,091 and 265 Brånemark implants, respectively, were included during a period between January 1986 and December 2003, and followed‐up for 5 years. Clinical information was retrospectively retrieved from patient files and intraoral radiographs were analyzed for examinations at prosthesis placement and after 1 and 5 years in function. Results: Altogether, 92 (48%) control and 24 (33%) study patients were lost to follow‐up during the 5‐year period. In total, 13 (4.9%) and 26 (2.4%) implants were in the study and control groups, respectively, were lost during follow‐up, resulting in a comparable 5‐year implant cumulative survival rate ranging from 93.9% to 99.3% for upper and lower jaws for study and control groups, respectively. Comparable mean marginal bone loss during 5 years, ranging from 0.4 mm to 0.6 mm, was also observed in the groups. The most common complications for patients in both study and control group were soft tissue inflammation (mucositis). Patients included in the first years of the inclusion (1986–1991) period showed comparable results as patient included at the last part of the inclusion period (1998–2003). Conclusions: Implant treatment in the partially edentulous elderly patients showed comparable clinical and radiographic results as elderly patients treated in the edentulous jaw.     

Fixed Implant‐Retained Rehabilitation of the Edentulous Maxilla: 11‐Year Results of a Prospective Study

Objectives: The aim of the present study was to assess long‐term survival and success rates of implants in the edentulous maxilla restored with an implant‐supported fixed prosthesis. Materials and Methods: Seventeen edentulous patients received six to eight implants and implant‐supported fixed prostheses by one surgeon. Yearly recalls were conducted by two examiners over a period of 11 years. Survival and success rates (biological complications) were determined; marginal bone loss was examined radiographically. Furthermore, microbiological tests as well as test for interleukin‐1 composite genotype were assessed and potential risk factors were evaluated. Results: After a mean time of 11.26 years, 15 patients of 17 could be reexamined. Out of 94 implants, three were lost in one patient. Mean marginal bone loss reached 0.88 mm, two patients (at seven implants) showed bone loss of ≥3.2 mm. Survival rate of implants reached 96.8%. Success rates on implant level hit 92.6% according to the criteria of Albrektsson and colleagues and 83.0% in accordance with Karoussis and colleagues. One prosthesis had to be renewed. Conclusion: Within the limitation of this study, restoration of the edentulous maxilla with an implant‐supported fixed prosthesis represents an effective tool for rehabilitation over a period of 11 years.     

Immediate functional loading of TiOblast dental implants in full‐arch edentulous maxillae: a 3‐year prospective study

Introduction: Immediate functional loading of dental implants for full‐arch restoration is a patient‐friendly approach, shown to be feasible with a good long‐term prognosis in a completely edentulous mandible. For the complete restoration of the maxilla, acceptable long‐term clinical follow‐up is lacking or based on case reports rather than on prospective studies. Objectives: This prospective mono‐centre study reports the 3‐year outcome of immediately functionally loaded Astra Tech Dental implants in completely edentulous maxillae based on clinical survival and success based on radiographical assessment of bone level. Material and methods: One hundred and ninety‐five Astra Tech TiOblast surface fixtures were installed in 25 consecutively treated patients (age range: 42–76 years), of whom eight were smokers, 12 had a confirmed history of periodontitis and six had poor bone quality normally deemed for delayed loading. Fixtures and abutments were inserted in a one‐stage procedure and functionally loaded within 24 h with a 10‐unit provisional glass‐fibre or metal‐reinforced screw‐retained restoration. After 6 months, each implant was checked for stability using a manual torque of 20 N cm and the provisional restoration was replaced by a 10–12‐unit screw‐retained metal–ceramic or metal–resin cantilever bridge. Bone level was assessed radiographically from the day of surgery up to 3 years and used to calculate mean bone loss at the patient level and individual implant success. Results: No failures occurred in implants or prostheses, the total survival rate being 100%. Mean marginal bone loss was 0.58 mm (SD 0.58); 0.6 mm (SD 0.53); 0.63 (SD 0.61); and 0.72 (SD 0.63) after 6 and 12 months, and 2 and 3 years, respectively, yielding a 100% success at the patient level. Wilcoxon's signed ranks test showed only statistically significant bone loss between baseline and 6 months and a steady‐state condition during all other intervals. At the individual fixture level, 82% lost <1 mm marginal bone between baseline and 1 year. After 3 years, 86% have <1.5 mm total bone loss and can be considered a success. The fixtures expressing more bone loss were all inserted in smokers. Conclusion: Immediate loading of a full‐arch maxillary bridgework on 7–9 Astra Tech TiOblast implants is a predictable treatment option with 100% fixture survival and stable bone‐to‐implant contact up to 3 years. The steady state in bone remodelling is indicative of a good long‐term prognosis in non‐smokers but smokers seem to be more prone to bone loss.