To implant or not to implant?

Your patient is 73 years old and medically compromised. It looks like your patient needs basic periodontal and restorative services that would benefit his oral health and prepare him to better receive and maintain any future implants planned. Treat him as you would like to be treated yourself and he will be fine.

I think that the patient should have non restorable teeth removed, periodontal therapy of remaining teeth and see how he does. If you are not comfortable with the medical management refer to an OMS. I do think improving this man's oral health will be very helpful for his pre diabetic condition and his fatigue. COPD patients need short appointments and proper positioning so their respirations are not compromised.

no teeth need extraction and no implants are required .this 73years old and medically compromised pt. need some conservative treatment and bridges work for his posterior teeth .his periodontal tissues look very fine specially in the anterior segments .treat him as you would like your father to be treated with and u the one who would bear the cost .

Carlos and CRS Ganesh good advice. Get him cleaned up and restore his teeth that are restorable. Take a slow course on OS and implants, a little at a time. Read up on his condition.

Just spoke to hematologist as of Monday and he has diagnosed the patient with myelofibrosis.

I agree with Carlos. First, the pt needs to take responsiblity for his dental health. He needs to increase his dental IQ and restore the caruous areas tht can be restored and get his periodontal condition stable. Then talk about implants. He is a medical rsik to extensive dentistry at this time(Implants). i If the patient is unwilling, then he should not be allowed to have implants.

The patient is partially edentulous, has generalized advanced cervical caries and bone loss. Hygiene is compromised but even if the patient becomes diligent, it is unlikely that conservative restorations will be effective for very long and if you crown teeth, the likelihood of recurrent decay is great. Both modalities will require multiple visits, multiple injections and escalating costs. At the first recurrence of decay or gum-line fracture, the patients motivation will evaporate. The hematologist has given the okay for surgical based treatment. Therefore I would consider extracting the remaining maxillary teeth and placing a complete denture, with consideration of future implants depending on the success with the denture. I would not move immediately into maxillary implants without a thorough consideration of the condition of the mandibular teeth. It may be that dollars are best spent down on the mandible. Regarding the patient taking responsibility for his dental health, we should remember that a great percentage of the implant patients we treat are edentulous. Chances are high that many of these people never took care of their teeth, but we don't deny them implants on that basis. I'd wager that few of us ask Mrs. Jones or Mr. Smith if they brushed and flossed 30 years ago.

I think it's better (for the patient) have non "restorable teeth removed, periodontal therapy of remaining teeth and see how he does". His pre diabetic condition and his fatigue can be a controindication for many hours of implantology. A good riconstruction, with endodontic therapy, can make the 4° and 5°, and 7° elements in condition to work for many years.