How old is too old for overdentures?
Age alone is not a contraindication for implant-retained overdentures, but age-related health conditions can be.
A significant part of the population is aging. The Baby Boomers, the second-largest generation in our society today, are getting older. They are hitting retirement age at the rate of 10,000 every day until 2030.1The oldest baby boomers, born in 1946, are around 73 years old, and the youngest, born in 1964, are 55.2
Per the American College of Prosthodontists (ACP), the geriatric population has a ratio of 2:1 for edentulous patients.3 With over 76 million people in the Baby Boomer generation, you may have many conversations with older patients about tooth replacement therapies in the coming years.
Since edentulism tends to be highest in the geriatric population, understanding the effects of age on implant success is significant to a dentist’s ability to treatment plan in these conversations with their patients. Particularly, when talking with the fully edentulous patient, it begs the question of how old is too old for overdentures?
Related reading: Baby Boomers and oral irrigation
Your patients might expect you to discuss a conventional, removable partial or complete dentures. Conventional dentures are prevalent with edentulous patients regardless of age. The ACP says 15 percent of the edentulous population have dentures made for their tooth replacement each year and 90 percent of all edentulous patients have dentures.4
However, it might be because they do not know about or understand the benefits of an implant-retained overdenture. When compared with removable dentures, patients prefer implant-retained overdentures. The International Journal of Oral Maxillofacial Implants published a study where 20 edentulous patients received implant-supported mandibular and maxillary dentures to replace their former prosthesis, and a significant increase in patient satisfaction occurred.5
So, are your older Baby Boomer patients too old for this preferred tooth replacement treatment? The answer is, maybe, maybe not. It all depends on the Baby Boomer.
What research says about age and implant survival
There are many considerations when you use implants with older edentulous patients, but age is not a significant factor by itself when you are considering whether to go with a removable or fixed prosthesis for fully or partially edentulous patient. Per The Australian Dental Journal, a systematic literature review of 17 studies on survival rates of mandibular implant overdentures supported by two implants showed a survival rate of 93 to 100 percent at ten years.6 Furthermore, the literature shows elderly patients were just as successful, and in some cases, more successful, with implant treatment than younger patients.7
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A study by The International Journal of Oral Maxillofacial Implants confirms this fact. Researchers compared two groups of patients, one with a mean age of 46 and another with a mean age of 68. Their results showed the implant-retained overdenture in the mandible was equally successful in both groups.8
It is important to note the researchers in both reviews said there should be more research on this specific question. Many times, in the research reviewed, age was not isolated as a causative factor for failure.9 Furthermore, the general health conditions accompany aging could affect survival rates, and they also were not isolated as a causative factor for implant failure.10 However, for the literature that does exist at this time, age alone is not a factor.
So, what is an essential consideration for the older edentulous patient?
If chronological age is not an indicator of whether a patient is a proper candidate for an implant-retained overdenture, what is? It turns out, many things, and some of them are age-related.
For example, as we age, we begin to experience endocrine, metabolic and physical changes, referred to as physiologic changes. An example here would be menopause. However, we also have specific medical conditions that occur with age and change our health, called pathologic changes. Some examples are diabetes, heart disease, pulmonary disease and arthritis, to name a few. While not linked to increased implant failure in the current literature, we know these changes affect a patient’s overall health, as well as their state of mind.
When speaking with mature or elderly patients about implant-retained overdentures, it is essential to consider their overall health condition, oral health and economic constraints. Per The Japanese Dental Science Review, age is a consideration, but not a determining factor by itself, nor should age be a contraindication.11 Instead, dentists should consider the specific disease that has led to the present condition (e.g., diabetes, osteoporosis, etc.) and the bone and soft tissue capacity available at the site of the implant when determining whether or not implants would be an option for treatment.12
Therefore, it isn’t a simple question or a simple answer for how old is too old for an overdenture. Treatment planning is individualized and based on the following considerations for an elderly patient:13
- Social, economic and time factors, meaning how much they want it, whether they think it’s worth hassling with and paying for, and whether they can afford it
- Individual assessment of maintenance requirements, which addresses whether they can take care of the restoration once it is delivered
- Risk of complications which takes into account their other health conditions
- Adaptive capacity of the patient, which considers whether they can accustom to the prosthesis chosen
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Also, it is crucial to identify these pathologic systemic conditions in the elderly before suggesting implant surgery for the edentulous patient:14
- Coronary diseases
- Anticoagulant treatment
- Diabetes
- Osteoporosis
Concerning physiologic aging, The Japanese Dental Science Review recommends having an awareness of how aging affects the body physically, metabolically and hormonally.15An example is the effects of hormone changes seen in post-menopausal women’s bone resorption rates, which increase after menopause and exceeds the bone resorption rates for men. However, both men and women lose the ability to heal bone as they age and bone density for both sexes decreases steadily after age 30.16
Read more: Study finds obstructive sleep apnea causes complications in dental implants
The Journal of the American Dental Association (JADA) recommends a comprehensive diagnosis of geriatric patients before treatment planning to provide for predictable esthetic and functional outcomes.17In addition to the areas already mentioned by the previous journals, JADA recommends assessing the patient’s history of:18
- Bruxism
- Periodontal disease
- Tobacco use
- Uncontrolled diabetes mellitus
- Metabolic diseases of the bone
Furthermore, JADA recommends having a conversation with the patient and his or her significant others to explain the details of the treatment plan, as well as obtaining a written and oral informed consent from the patient. Also, they recommend making the prosthesis during the diagnostic phase, whether the plan is for removable or fixed or a combination thereof. Clinicians should also assess the hard and soft tissue changes and set reasonable patient expectations.19
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Overdentures benefits and drawbacks for seniors
Once you decide to move forward with a treatment plan that includes an implant-retained overdenture, it is incumbent on you to communicate the benefits to those patients. The two most commonly cited benefits are the retention aid they have for maxillary dentures and the reduction in covering the palate. Also, the ability to remove and clean the overdenture thoroughly is a significant benefit.20
It would also be crucial to include the drawbacks that occur with this solution. The survival rates of maxillary overdentures range from the low 70th percentiles to the low 80th percentiles, with the time ranging from five to seven years.21Some studies indicate there are higher maintenance costs with this option, too, which is a significant consideration for patients and their families.22
That said, one study showed patients preferred maxillary overdentures over fixed prostheses. In the study, participants had a mandibular overdenture and alternated between a maxillary overdenture and a fixed maxillary prosthesis. The participants said they liked the removable maxillary overdenture in general better than the fixed, and liked it better for talking and cleaning, as well.23
Related reading: How to simplify overdenture treatment for today's patients
So…how old is too old for overdentures?
Our research revealed our question, “How old is too old for overdentures?” is flawed. Chronological age alone is not the indicator to use. The health of your elderly patient is. The health of your older patient is affected by age in ways a younger patient is not. Ultimately, when it comes to age and the edentulous patient, the answers are found in the individual and not general guidelines.
We would amend our question to say, “How healthy is my patient and is their bone ready for overdentures?” The answers to that question point you to the most predictable outcomes for your elderly patients with overdentures.
To read the resources used for this article in full, please click below:
Dental Implants: A Role in Geriatric Dentistry for the General Practice?
Implants for the ageing population
Is old age a risk factor for dental implants?
Referenes:
1 “The Baby Boomer Generation.” www.seniorliving.org. Web. 17 July 2019. <https://www.seniorliving.org/life/baby-boomers/>.
2 Ibid.
3“Fact & Figures.” www.gotoapro.com. Web. 13 July 2019. < https://www.gotoapro.org/facts-figures/>
4 Ibid.
5Krennmair G1, Seemann R, Fazekas A, Ewers R, Piehslinger E.“Patient preference and satisfaction with implant-supported mandibular overdentures retained with ball or locator attachments: a crossover clinical trial.” Int J Oral Maxillofacial Implants. 2012 Nov-Dec;27(6):1560-8. Accessed via web: 18 June 2019. < https://www.ncbi.nlm.nih.gov/pubmed/23189311>.
6 Dudley, J. “Implants for the ageing population. Australian Dental Journal. 2015:60 1 Suppl): 28-43 Accessed via web. 13 July 2019. < https://onlinelibrary.wiley.com/doi/pdf/10.1111/adj.12282>.
7 Ibid.
8 Clark, Stanford. M. “Dental Implants.” The Journal of the American Dental Association. :138; 34-40; Accessed via web. 17 July 2019. <https://jada.ada.org/article/S0002-8177(14)62741-0/fulltext>.
9 Dudley, J. “Implants for the ageing population. Australian Dental Journal. 2015:60 1 Suppl): 28-43 Accessed via web. 13 July 2019. < https://onlinelibrary.wiley.com/doi/pdf/10.1111/adj.12282>.
10Ibid.
11 Ikebe, Kazunori; Wada, Masahiro; et al. “Is old age a risk factor for dental implants?” Japanese Dental Science Review. 2009:45; 59-64; Accessed via web. 17 July 2019. < https://www.sciencedirect.com/science/article/pii/S1882761609000039>.
12 Ibid.
13Dudley, J. “Implants for the ageing population. Australian Dental Journal. 2015:60 1 Suppl): 28-43 Accessed via web. 13 July 2019. < https://onlinelibrary.wiley.com/doi/pdf/10.1111/adj.12282>.
14 Ikebe, Kazunori; Wada, Masahiro; et al. “Is old age a risk factor for dental implants?” Japanese Dental Science Review. 2009:45; 59-64; Accessed via web. 17 July 2019. < https://www.sciencedirect.com/science/article/pii/S1882761609000039>.
15 Ibid.
16 Ibid.
17 Clark, Stanford. M. “Dental Implants.” The Journal of the American Dental Association. :138; 34-40; Accessed via web. 17 July 2019. <https://jada.ada.org/article/S0002-8177(14)62741-0/fulltext>.
18Ibid.
19 Ibid.
20 Dudley, J. “Implants for the ageing population. Australian Dental Journal. 2015:60 1 Suppl): 28-43 Accessed via web. 13 July 2019. < https://onlinelibrary.wiley.com/doi/pdf/10.1111/adj.12282>.
21 Ibid.
22 Clark, Stanford. M. “Dental Implants.” The Journal of the American Dental Association. :138; 34-40; Accessed via web. 17 July 2019. <https://jada.ada.org/article/S0002-8177(14)62741-0/fulltext>.
23 Ibid.
