Anon, from California, asks:
I attempted to place a dental implant on a healthy 80 year old #19 area. I had a CT Scan and there was ample width and depth for a 13 mm implant. The pilot drill easily went into the bone. I used the 3.5 drill to depth and went to place the 4.3 mm implant, skipping the 4.3mm drill.
The implant would not screw into the bone after it reached the tissue height. I put some pressure on the driver and the dental implant sank down about 2 mm. I could see the implant angulated in the bone not angulated properly. I then realized that the bone was ” hollow “. I retrieved the implant, placed some Bio-Oss and sutured. I told the patient that her bone was not suitable for an implant. I then went to my CT and the Hounsfeld units were 56 in that region. Other places in the mandible were 150. It appears that in the geriatric population bone density could be a problem. Any thoughts? Have you also seen this in this segment of the patient population?
Youneed to check the HU way before any attempt. You could have possibly grafted beforehand and come out ahead. I had one fail without using a CT but it was sound. No Meds an issue. She just didnt heal fast as someone 30 y/o and I needed to wait longer. Get all you can out of the CT. Its the tool that tell you alot and especially if its ICT. Bill
After the age of 40, bone may be lost at a rate of 0.2–0.5% per year in both men and women. Endocrine changes, nutrition, body weight, exercise levels, the overall level of somatic and psychological health and genetic predisposition influence the rate of bone loss, which increases to 2–5% annually around menopause but can be reduced by hormone-replacement therapy. In men and older women (beyond 10 years after the menopause) nutritional deficiencies are critical for osteoporosis. Osteoclasts are particularly sensitive to immune-system-derived messages, primarily cytokines. During chronic illness, increased levels of inflammatory cytokines shift the balance between bone formation and bone resorption in favor of the latter. Osteopenia, osteoporosis or even decreased linear growth and lower peak bone mass are often associated with a chronic disease. Estrogen deficiency intensifies the impairment of intestinal calcium absorption and contributes to bone loss. Only half of patients with vitamin D deficiency are found to have secondary hyperparathyroidism. This insufficient PTH response may be related to magnesium deficiency because women in the low-vitamin D and low-PTH group showed evidence of magnesium depletion. Subclinical zinc and/or copper deficiency due to a reduced dietary intake or reduced absorption may contribute to bone loss in the elderly. Zinc and copper are cofactors for enzymes important for the synthesis of bone matrix components. Due to inhibition of absorption of zinc and impairment of retention of copper, calcium supplementation may aggravate zinc and copper deficiency. At age 80 years or older, the prevalence of osteoporosis as defined by T-score. A T-score of
At age 80 years or older, the prevalence of osteoporosis as defined by T-score. A T-score of < =-2.5 is about 70%. The risk of vertebral fracture in women over age 80 exceeds 50%. The US Surgeon General issued a comprehensive report on bone health and treatment summarizing the magnitude of the problem and the poor outcomes associated with osteoporosis. The report states that advances over the past 15 years permit informed individuals and practitioners to take an aggressive course of action leading to better prevention and treatment. Education for health care providers and patients is strongly encouraged. Bone health should be discussed with patients beginning with children and adolescents and continuing throughout all later stages of life. Use this link to see the report.
Hi, I think you may find interesting a work about a osseointegration in postmenpausal women we did some time ago. You can see an abstract at
Regards,
Cesar
Dear Dr.Jafari,
i am a periodontist working on implants for over 17 years starting to use blade shaped implants in 17 years ago and have been using many different systems since then .i bilieve that mini implants can be very good ones for elderly paitents according to osteo malacia and bad nutrition in our country.
they dont need flaps,several sequenses of drilling Etc.and i have 4 years experiens in working with MDI and osteo care minies,and all my old paitents has been satisfied,either because of non surgical procedure or simplicity and also the much lower cost specially if thy are used as over denture fixtures.
may i know your comments on these kinds of implants for paitents over 60 comparing the result in Iran and any other country (if such a research exist).thanks in advance
Dr C Behnam,
Recently my 90 yr old lost a bridge in her mouth and was told it had been put in wrong. Now they want to do implants. I requested she get a 2nd opinion but was interested in your comments about the MDI and osteo care minies. Can you tell me where you practice? And is this something I can ask the dentist about when she goes?
thanks
Hi Dr C Behnam,
that’s my 90 yr old mother, sorry I left the mother out of my first communication.
Yes mini implants are a solution in such age related cases with flapless surgical approach and most economic.We hve done several cases and are functioning for age between 60 to 80 very well even many re diabetic patients.
has any colleague heard anything about placing 40 mm fixtures in zygoma where maxilla bone is not sufficient to accept them?
i have done this surgery in 1985 on a 45 years old lady(now 70)and they are still functioning properly.
i will be pleased to open a dialogue about how to use the medico-creative mind to help the patients,and if needed i can attach xrays or other information about this paitent or other patients treated in the same way in past 25 years.thanks