Geriatric dentistry is the area of dentistry dedicated to oral health care in the elderly. In Chile, there is a clear trend towards an increase in life expectancy and it is expected that by 2025 the percentage of older adults will reach 20% of the population. In this group of patients there is a significant prevalence of chronic diseases such as hypertension and diabetes, in addition to living with polypharmacy. Regarding their oral health, unfortunately they are patients who have lost several or all of their teeth, that is, a significant mutilation of teeth due firstly to dental caries and secondarily to periodontal disease (chronic infection that damages supporting tissues of the tooth, ie bone tissue and gums). The fact of losing teeth not only limits the chewing and aesthetic function, but also deteriorates the quality of life of the elderly with respect to their nutritional level, self-esteem and social relationships. The obvious difficulty to eat and grind food, to converse, express oneself and smile make this very localized dental condition deeply affect the bio-psycho-social development and the dignity of our older adults.
Dental implants have been a revolution in dentistry and an invaluable contribution to the oral rehabilitation of patients. The dental implant is a device that simulates an artificial root, that is, an element very similar to a screw that is anchored in the bone and that after approximately 2 to 3 months of osseointegration, is incorporated into the bone structure . After this period, the prosthetic element can be connected, which is finally what the patient wants, to have teeth again.
Implantology has made it possible to rehabilitate with fixed prostheses cases that in the past could only be solved with removable prostheses. Today it is possible to restore their function and health to total edentulous patients through implant-supported prostheses. On the other hand, in patients who have had localized loss of teeth, it is possible to rehabilitate them with implants and implant-supported crowns or bridges, thus avoiding damaging and wearing adjacent teeth to support a plural fixed prosthesis. In addition, it is important to mention that in older adult patients who already have removable total prostheses, the insertion of 2 or more implants can significantly improve the stability and retention of the prostheses that the patient already has.
Unfortunately, the severity in the loss of teeth is related to the socio-economic level, basically due to lack of education and promotion of habits regarding self-care in oral health. Therefore, oral implantology continues to be an expensive treatment for people who need it most and exclusively for people with greater resources. Hopefully in the future, public health strategies will be developed that allow this type of treatment to reach our most vulnerable older adults with limited resources. It is a debt that we have as a society and a country.
Scientific evidence reports implant success over 95%. Therefore, considering the high predictability of implant treatment and the benefits it provides to the patient from a functional, aesthetic and social point of view, it is an absolutely recommended and safe treatment for our patients. The fundamental requirement for a successful implant treatment is the correct diagnosis and a careful and individualized treatment plan for each patient. The clinical evaluation together with complementary tests, such as study models and three-dimensional imaging, allow us to plan adequately and reach a successful conclusion. Basic and fundamental condition to install implants is to have adequate bone structure in quantity and quality to anchor these fixations. This is how the Oral Implantology specialty is dedicated not only to the surgical placement of implants and their prosthetic rehabilitation, but also to the development of sites with bone grafts to regenerate bone where there are significant bone defects.
Any patient can be a candidate for implant treatment, excluding some specific medical conditions. Regarding smoking patients, there is a greater risk of having complications, which the patient should be aware of, but treatment is not contraindicated. There are few contraindications to implant treatment, including specific bone metabolic diseases, bisphosphonate treatment, anticoagulant treatment that cannot be suspended, patients undergoing radiotherapy treatment and mainly psychiatric diseases. It is understood that bone cell metabolism is critical and must not be impaired to be successful with this therapy.
Conditions such as elderly patients, osteoporosis or diabetes are not a contraindication for this type of treatment, but patients with some of these pathologies or others must be controlled and medically stable. Some considerations must be taken regarding a slowed bone cell metabolism, diminished regeneration and healing capacities, and therefore be more patient and wait a longer time for the osseointegration process.
Implant surgery is a procedure that is performed under local anesthesia in the ward and generally has a very well tolerated post-operative period by our patients. For patients who are fearful or very anxious, we can perform this procedure under intravenous sedation, with which the patient enters a deep sleep where they will not remember anything about the procedure at all.
My greatest joy as an Implantologist is to see the satisfaction of the patients once the treatment is finished, which is not only limited to the impact on their dental health, but also allows them to improve their quality of life and their self-esteem.
Dr. Paulina Barrientos Ramwell
Oral Rehabilitation & Oral Implantology
San Sebastián Dental Clinic