The worlds elderly population is growing rapidly and despite improvements in oral health and tooth retention the need for complex oral restorative and rehabilitation is anticipated to rise. One consequence is likely to be increased demand for dental implants based restorative treatment in older patients.

The aim of this review was to evaluate the outcome of dental implant therapy in the elderly population aged 65years or over.

Methods

Searches were conducted in the Pubmed, Embase, Cochrane CENTRAL and Web of Science databases supplemented by other online sources (Google, Yahoo, and Researchgate). Prospective studies reporting on regular-diameter (≥3 mm), micro-rough surface implants in adults over 65yrs were considered. Studies published in English, French and German were included. Two reviewers independently selected studies, abstracted data and assess risk of bias. The Cochrane tool and Newcastle-Ottawa scales were used to assess risk of bias. The primary outcome measure was implant survival rate.

Results

• 11 studies ( 2 RCTs, 1 Cohort, 1 case-control, 1 prospective comparative, 6 prospective case-series) were included.
• The authors considered that all the included studies should be considered as prospective case series.
• A random-effects meta-analysis was performed on the post-loading implant survival rates at 1, 3, 5, and 10 years.

	No. of Studies	Implant survival (95%CI)	PI-MBL
1-year	11	97.7% (95%CI; 95.8 – 98.8)	0.1 -0.3 mm
3-year	6	96.3% (95%CI; 92.8 -98.1)	NR
5-year	7	96.2% (95%CI; 93.0 – 97.9)	0.7mm
10-year	3	91.2% (95%CI; 83.4 -95.6)	1.5 mm

• Information regarding technical and biological complications in the included studies was inadequate for statistical analysis.
• Frequently reported technical/mechanical complications were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, and fractures.
• The common biological complication reported included peri-implant mucositis, mucosal enlargement, bone loss, pain, and implant loss.

Conclusions

The authors concluded:-

This systematic review provides robust evidence favouring dental implant therapy in elderly edentulous patients as a predictable long-term treatment option in terms of high implant survival rates, clinically acceptable PI-MBL changes, and minimal complications. Therefore, age alone need not be considered a factor in effectuating dental implant therapy, and implants should be a recommended treatment option in the rehabilitation of elderly edentulous patients in order to help improve their oral function and quality of life.

Comments

This systematic review has adopted standard methodological approaches identifying a small number of prospective studies addressing the topic. The meta-analysis provides survival rates for implant in patients over the age of 65 at 1,3 5 and 10 years of, 97.7%, 96.3%, 96.2%, and 91.2% respectively. The authors have also conducted a sensitivity analysis where they consider all those implant lost to follow up as failed which reduces the survival rates to 95.6%, 91.7%, 91.2%, and 80.5% respectively.

While the authors consider the included studies to be of ‘superior quality conducted by well-known and senior researchers’ although no formal assessment of quality of the studies has been conducted and all of the included studies are small with the number of patients included in them ranging from 10 to 31. As a consequence the findings of the review should be interpreted cautiously as providing evidence to suggest favourable outcomes in elderly patients rather than robust evidence and indicated in the authors’ conclusions.

Links

Primary paper

Srinivasan M, Meyer S, Mombelli A, Müller F. Dental implants in the elderly population: a systematic review and meta-analysis. Clin Oral Implants Res. 2016 Jun 7. doi: 10.1111/clr.12898. [Epub ahead of print] Review. PubMed PMID: 27273468.