itself is not a limiting factor for implant therapy . Also , there is no limit to using biomaterials for reducing morbidity .
When an implant is not the first choice .
Sometimes a disease or the side effect of treatments contraindicate implant therapy . Cancer alone is not a contraindication . But when it is treated with radiotherapy or chemotherapy , or when the patient receives antiresorptive , bisphosphonate therapy for the treatment of bone metastases , then implant therapy may not be the best option .
Also , I do not recommend implants when signs of cognitive decline and related deterioration of motor coordination are diagnosed . Alzheimers and dementia are progressive , and we do not have a treatment for them yet . So we need to provide appropriate retention , e . g ., with adhesives . It may be less comfortable and less pleasant , but at the end of the day , we will be able to keep the patient ’ s mouth clean . Without the appropriate oral hygiene , every solid surface in the mouth may crystalize biofilms , which could later cause aspiration pneumonia . In elderly people , oral hygiene has a preventative effect on mortality from pneumonia .²
Complication rate increases with dexterity decline .
We know that the risks of complications in the elderly are similar to those in younger patients as long as the patients can accomplish independent hygiene .¹ The risks increase when they are not able to perform oral hygiene themselves . In this case , we need to accompany our patients along their journey of functional decline , e . g ., by de-sophisticating the denture and simplifying retention step-by-step . For example , when the patient is not able to clean the fixed prosthesis anymore , we can change it to a removable prosthesis , probably with bars or stud attachments . When manual dexterity declines further , we can change the abutment for ball attachment , or magnets , and at the end of the process , when the patient becomes too fragile , it may be prudent to remove the abutment , fill the component with provisional reline , and prescribe denture adhesives .
Compliance and the paradox of geriatric dentistry .
Elderly patients are a dentist ’ s dream customers . They are punctual , they have time for follow-up visits , and they still believe in the white coat , which means they take doctors ’ advice very seriously . And they can also be less demanding than younger patients . We call this the “ paradox of geriatric dentistry ,” whereby patients better accept situations that the dentist considers dissatisfactory or requiring urgent treatment . This attitude may create a discrepancy between treatment need and demand . Nevertheless , the patient ’ s inability to follow our instructions , due to their dexterity , func- tional or cognitive decline , should not be considered “ non-compliance .” Above 90 , one out of three patients may have dementia . Although we may see the first signs , diagnosis should be confirmed by a specialist . Yet diagnosis is important , because it will have a big impact on our treatment planning . Approximately 6 – 8 years may pass between diagnoses of dementia and death , and towards the end the patient may not be able to comply with hygiene measures or dental treatments . This is why dementia patients have more untreated caries and / or periodontal disease , a higher prevalence of tooth loss and also difficulties using their dentures .
We can ’ t leave these patients alone .
Professional ethics oblige us to follow the patients and make sure they have access to care and oral hygiene . As these patients generally visit their doctors more often than their dentist , physicians and also family members can help detect issues . We need manpower for primary screening , and it is easy to train a family member to supervise the patient or support them when dependency increases . Most patients arrive at our office accompanied by a son , sister or partner who is somewhat fitter . We train these “ caregivers ” how to supervise oral hygiene or handle dentures , and we point out the weak points and important issues , along with what they need to do when they occur .
Digital dentistry is the future .
Of all technical advances , digital dentistry has made the biggest impact on gerodontology by bringing access to many
Geistlich Podcast All Ears on Regeneration
Listen to the podcast and interview with Prof . Müller on “ All Ears on Regeneration ”.