Next Article in Journal
Effects of Fremanezumab on Psychiatric Comorbidities in Difficult-to-Treat Patients with Chronic Migraine: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry
Previous Article in Journal
A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 12
Issue 13
10.3390/jcm12134524
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Immediate Loaded Full-Arch Mandibular Rehabilitations in Younger vs. Elderly Patients: A Comparative Retrospective Study with 7-Year Follow-Up

by
Paolo Capparè
1,2,*,
Giulia Tetè
1,2,
Bianca D’Orto
1,2,
Matteo Nagni
1,2 and
Enrico Felice Gherlone
1,2
1
Dental School, Vita-Salute San Raffaele University, 20132 Milan, Italy
2
Department of Dentistry, IRCCS San Raffaele Hospital, 00163 Milan, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(13), 4524; https://doi.org/10.3390/jcm12134524
Submission received: 30 May 2023 / Revised: 14 June 2023 / Accepted: 2 July 2023 / Published: 6 July 2023
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
Versions Notes

Abstract

:
The aim of this comparative retrospective clinical study was to assess the effect of age on immediate loaded full-arch mandibular rehabilitation in younger vs. elderly patients. Patients with an age between 45 and 60 years (younger group, YG) or with an age more or equal to 75 years (older group, OG), requiring a mandibular full-arch rehabilitation were scheduled for the present study. Implant and prosthetic failure, biological and prosthetic complications, and peri-implant marginal bone level changes were recorded until a 7-year follow-up. Sixty-six patients were included in the study; a total of 264 implants were placed and, in total, 66 “all-on-four” rehabilitations were delivered. In total, 33 patients were scheduled in the YG and 33 patients in the OG. At the 7-year follow-up, an overall implant failure rate of 1.14% was reported. Moreover, at the 7-year radiographic evaluation, peri-implant crestal bone loss averaged 1.12 ± 0.91 mm for the YG and 1.04 ± 1.01 mm for the OG. No statistically significant differences were found between the YG and OG except for the rate of peri-implantitis, which was statistically higher in the YG. The present study reported that immediate fixed mandibular full-arch rehabilitation is a viable procedure in elderly people of equal or more than 75 years of age.

1. Introduction

Global demographic trends expect a world population of 9 billion people by the year 2050, with an increase of 50 million annually, probably due to a multitude of factors such as increased life expectancy, reduction in mortality, slow growth, and urbanization [1]. Indeed, it is estimated that in the United States alone, the elderly population (>65 years) will double by the year 2050 [1,2,3,4,5,6,7].
In a clinical study, the authors emphasized that the population will tend to live longer and will, therefore, require endosseous implants to maintain their mandibular overdenture, considering, of course, the economic aspects that could be influential in the choice between removable prosthesis, less expensive prosthesis, and fixed prosthesis [8].
In another study, it was suggested that serum factors typical of middle-aged and aged individuals could be responsible, at least in part, for the altered responses observed during wound healing in aging [9].
Furthermore, a reduced bone formation response to mechanical loading has been shown with aging and it remains unknown if the interplay between aging and mechanical stimuli during regeneration is similar to adaptation [10,11,12,13].
Several studies have been carried out on implant rehabilitation in elderly patients, but they are retrospective for the majority, and the prospective ones involve a small number of patients and mention mainly single implants or conventional rehabilitation [14].
Indeed, a review by Srinivasan et al. reported an implant survival of 97.7% in elderly patients who have performed traditional implant-supported rehabilitation [15]. Other studies showed that there are no significant differences between young and old patients in dental implant outcomes [16,17,18,19,20].
Nevertheless, implant-prosthetic rehabilitation is a highly predictable therapeutical option for partially/completely edentulous jaws, also when implant placement could be limited by anatomical conditions [21]. Indeed, in the atrophic mandible, the anterior region usually maintains an adequate bone volume while in the posterior areas, a severe resorption is present, with a reduced quantity and quality of available bone [22,23,24,25,26].
Malò et al. reported, at the long-term follow-ups, that the “all-on-four” is a technique that involves the use of four implants, two axial and two tilted, to avoid anatomical structures at risk without the use of bone grafting procedures [27]. The clinical outcomes of such a procedure, with four implants to rehabilitate an edentulous jaw, were well described in the literature, with favorable 5 to 10-year results [28].
As Cattoni et al. described in 2021, the “all-on-four” digital protocol represents a viable therapeutic choice for implant-supported rehabilitations of edentulous dental arches [29,30,31,32].
Therefore, the aim of this retrospective clinical study was to compare mandibular “all-on-four” rehabilitation outcomes in younger versus older patients at 7-year follow-ups.
The null hypothesis was that there were statistically significant differences between young and elderly in implant failure, biological and prosthetic complications, and marginal bone loss.

2. Materials and Methods

2.1. Patient Selection

This comparative retrospective clinical study was performed at the Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy. The ethics committee approval number is 190/INT/2021.
The study was conducted in accordance with the tenets of the Declaration of Helsinki and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cohort studies (http://www.strobe-statement.org, accessed on 24 April 2021). During the period from January 2014 to December 2021, patients needing full-arch rehabilitation of mandible were evaluated according to the following inclusion criteria:
  • All patients had to be edentulous or with only a few hopeless teeth in the mandible and all presented with severe atrophy in posterior regions;
  • Sufficient residual bone volume to receive four implants according to the “all-on-four” protocol;
  • All patients had to be an age comprised between 45 and 60 years or equal to or more than 75 years;
  • All patients had to be independent of help for the activities of daily living;
  • All patients had to be in good health.
The exclusion criteria were as follows:
  • Patients with contraindications to undergoing implant-prosthetic rehabilitation as severe cognitive impairment (dementia), uncontrolled systemic diseases, taking bisphosphonates [33], or radiation therapy of the head and neck within 1 year;
  • Poor oral hygiene;
  • Smoking more than 15 cigarettes/day;
  • Parafunctional habits (bruxism, clenching);
  • Inadequate bone volume;
  • Inability to maintain an obligation to implant treatment and maintenance;
  • Inability or reluctance to provide informed consent;
  • Depression, psychiatric problems, or unrealistic expectations;
  • Drug abusers [34];
  • Active infection/severe inflammation in the area intended for implant placement [35];
  • Participation in other trials if the present protocol could not be properly followed.
Patients with ages between 45 and 60 years were scheduled in the younger group (YG), while patients with ages equal to or more than 75 years were included in the older group (OG).
All diagnoses were made clinically and radiographically. Written informed consent for immediate implant loading was obtained from all patients prior to the implant-prosthetic procedures; professional oral hygiene was provided before surgery. Conventional impressions were taken for study models and temporary prostheses. To assess bone volume (according to Cawood and Howell classification [36]) and bone density (according to Lekholm and Zarb classification [37]) in each patient, the diagnosis was conducted at the first level with orthopantomography and at the second level with CBCT.

2.2. Implant-Prosthetic Protocol

All surgical procedures were done in full safety for the patient’s general health and in consideration of the change of protocols following the COVID-19 pandemic emergency [38,39].
All surgeries were performed by a single experienced surgeon (PC). On the day of surgery, implants were positioned after antibiotic prophylaxis with 2 g of amoxicillin and clavulanic acid (Augmentin, GlaxoSmithKline, Belgium), which was administered 1 h prior to the surgical procedure. The implant surgery was performed under local anesthesia (optocaine 20 mg/mL with adrenaline 1:80,000, Molteni Dental, Florence, Italy).
The implant-prosthetic procedures were performed following Malò’s “all-on-four” protocol [40], already adopted by our Department and described in previous studies [41,42].
The diameter of the final drill was chosen based on bone quality to optimize implant stability. The insertion of the implants followed standard procedures (Winsix, Biosafin, Ancona, Italy), although under-preparation was used in the soft bone to achieve an insertion torque ranging between 30 and 40 N·cm before the final seating of the implant, thereby obtaining high primary stability and immediate function. A manual wrench was also used when incomplete seating of the implant occurred. The implant neck was aimed to be positioned at bone level, and the bicortical anchorage was established whenever possible.
After surgery, mouth rinsing with a chlorhexidine digluconate-containing solution (0.12% or 0.2%), twice a day for 10 days, was prescribed in addition to the recommended standard post-surgical medication: amoxicillin and clavulanic acid (Augmentin, GlaxoSmithKline) 1 g, twice a day for 7 days after surgery and non-steroidal anti-inflammatory drugs (Brufen 600 mg, Abbott Laboratories, Chicago, IL, USA) as needed. All patients were instructed to avoid brushing and any trauma to the surgical site and were recommended to follow a soft diet (avoiding bread and meat) for 2 months. One week after implant placement, sutures were removed [43,44].
After surgery, a low-level laser therapy protocol was performed with a 645 nm diode laser to reduce inflammation of the tissues and to improve the healing phase of the tissues (diode laser, 645 nm, 0, 6 Watt) (EGG Laser, DMT, Lissone, Italy) [45,46,47].
Within 24 h after surgery, provisional full-arch all-acrylic resin prostheses were delivered to all patients based on preliminary impressions.
In the final prosthesis, the occlusion reproduced the natural dentition with distal cantilevers till the first molar. The pontic areas had an ovate design and the prosthesis provided an intimate contact with the underlying soft tissues but with the cleaning space necessary for the home care oral hygiene.
In addition to the restoration of esthetics and function, the patient after an implant rehabilitation also improves in their general state of health which is related to an increase in the quality of life [48,49,50,51,52].

2.3. Follow-Up

Follow-up visits were performed at 3 and 6 months, then yearly until the 7-year follow-up after implant placement; every 6 months after implant placement, a dental hygienist performed oral hygiene procedures and recorded the clinical parameters, including BI, plaque index, and probing depth around implants [53].
Patients occasionally failed to visit the hygienist but were always recalled for another appointment.

2.4. Outcome Measures

The outcomes considered were as follows:
1. Implants failure: implant removal dictated by mobility, progressive marginal bone loss due to peri-implantitis, or any mechanical complication rendering the implant not usable (e.g., implant fracture). The stability of each individual implant was assessed manually for 6 months and then yearly from insertion by tightening the abutment screws with the removed prostheses.
2. Biological and prosthetic complications (number and type) were recorded as single episodes for each implant. Particular attention was used to assess peri-implantitis (defined as a progressive and irreversible disease of hard and soft tissues around dental implants associated with bone loss and signs of infections), presence of pain, presence of pus, paresthesia in the lower jaw, and implant fracture.
3. Peri-implant marginal bone level changes (MBLCs): Radiographic assessments were made using periapical radiographs obtained immediately after surgery and at each follow-up visit. Bone level measurements were performed on the mesial and distal aspects of each implant using the implant–abutment junction as a reference point; they were made perpendicular to the long axis of the implant with the long-cone parallel technique using an occlusal custom template to measure the MBL. A dedicated dentist measured the changes in crestal bone height over time. The difference in bone level was measured radiographically through custom software (DIGORA 2.5, Soredex, Tuusula, Finland). The software was calibrated for each image using the known implant diameter at the most coronal portion of the neck of the implant. The linear distance between the most coronal point of bone-to-implant contact and the coronal margin of the implant collar was measured to the nearest 0.01 mm at both the mesial and distal sides and then averaged. Marginal bone loss was calculated as the difference in peri-implant bone levels between the first (immediately after fixture placement) and last (during the recall visits) radiographs, and the change in crestal bone height was measured over time. Bone level changes at single implants were averaged at the patient level.

2.5. Statistical Analysis

Statistical analysis was carried out using Python 3.8.5 and the following packages: math, sciPy, and pandas. According to the sample distribution, variance, and experimental setting, we used parametric independent samples t-test, Pearson’s chi-square test, or z-test to test for/against differences between groups. Across all analyses, p-values < 0.05 were considered significant. Data were analyzed at the aggregate level.
To investigate differences in terms of implant failures and biological and prosthetic complications between groups, Pearson’s chi-square and z-tests were applied at a significance level of p < 0.05.
To compare marginal bone loss between groups at 6 months and annually until the 7-year follow-up, Pearson’s chi-square and Student’s t-tests were applied at a significance level of p < 0.05.
The null hypothesis was that there were no statistically significant differences between the groups compared.

3. Results

In total, 87 patients with ages between 45 and 60 years and ages equal to or more than 75 years, needing mandibular full-arch rehabilitations, were screened at the Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy. Among them, 66 patients met the eligibility criteria and were included in the study.
A total of 33 patients were allocated in the YG, while 33 patients were included in OG.
Among them, eight patients (12.90%) were smokers, all from the YG.
According to the “all-on-four” protocol, a total of 264 implants were placed in 66 patients (Table 1) and, in total, 66 “all-on-four” rehabilitations were delivered.
In the YG, 13 patients out of 33 were affected by controlled systemic diseases, while in the OG, 29 out of 33 patients were affected by controlled systemic diseases (Table 2). Moreover, in the YG, two patients were affected by two systemic diseases (hypertension and diabetes in both cases), while in the OG 12 patients were affected by two systemic diseases and three patients by three systemic diseases (Table 2).
In the OG, four drop-outs occurred: one patient died from melanoma at 3.5 years from immediate loading, one patient died from lung cancer at 2 years from immediate loading, one patient died from heart ischemic disease at 1 year from loading and one patient died from a stroke at 6 years and 2 months from loading.

3.1. Implant Failure

Implant failure was registered in three patients (3 of 264 fixtures) (Table 3): two implants were lost in the YG and one implant in the OG. Details of the lost implants were reported in Table 3. Moreover, two out of three patients who lost implants were affected by systemic diseases, but no patients were smokers. In each case, implants of the same length and larger diameter were replaced by changing the implant seat. No implant fracture occurred.
So, at the 7-year follow-up, an overall implant failure rate of 1.14% was reported, with a failure rate of 1.52% for the YG and a failure rate of 0.76% for the OG. The differences between the two groups, at a 95% confidence level, appear not to be significant enough to reject the null hypothesis, and the two groups should be considered statistically not different.

3.2. Biological and Prosthetic Complications

Peri-implantitis was observed in 11 of 264 implants (4.17%) and 8 of 66 patients (12.12%) (six from YG and two from OG) at the 7-year follow-up. Fractures of provisional prostheses occurred in 4 patients and in 4 of 66 rehabilitations before the 6-month follow-up. In total, two patients were from the YG and two patients were from the OG. No paresthesia and no prosthetic complications in definitive prostheses were registered in any of the patients.
The differences between the two groups, at a 95% confidence level, appear to be significant enough to agree with the null hypothesis, and the two groups should be considered statistically different. Peri-implantitis resulted statistically significantly more frequent in the YG than the OG (p = 0.00031).

3.3. Peri-Implant MBLs

MBL outcomes were reported in Table 4. Both axial and tilted implants showed good maintenance of bone levels in both the YG and OG. At the 7-year radiographic evaluation, peri-implant crestal bone loss averaged 1.12 ± 0.91 mm for the YG and 1.04 ± 1.01 mm for the OG. No statistically significant differences in marginal bone loss between Group A and Group B were observed at any of the follow-up evaluations (p > 0.05). The differences between the two groups, at a 95% confidence level, appear not to be significant enough to reject the null hypothesis and the two groups should be considered statistically not different.

3.4. Prosthetic Failure

In total, 4 of 66 fixed provisional prostheses were fractured during the observation period, representing a provisional prosthetic fracture rate of 6.01% (Table 5). Among definitive prostheses, no failure was observed, and no fracture of the acrylic resin superstructure occurred.
No statistically significant differences in prosthetic complications (provisional prosthesis fracture, provisional screw loosening (abutment), provisional screw loosening (prosthetic), and detachment of the veneering material (final prosthesis)) between Group A and Group B were observed (p > 0.05). The differences between the two groups, at a 95% confidence level, appear not to be significant enough to reject the null hypothesis and the two groups should be considered statistically not different.

4. Discussion

This study allows us to compare implant survival between a group of younger and a group of older patients, providing support in the clinical practice of implant rehabilitation according to the “all-on-four” technique. Indeed, the current literature on implants in elderly people focused on overdentures, single implants, and implants in the esthetic zone but no one reported immediate loaded full-arch rehabilitation, despite being a method widely used and endorsed by the scientific literature [15,54].
Malò, in his article on 1070 patients at 13 years of follow-up, says that the “all-on-four” treatment concept is predictable and safe in the long-term outcome [55].
Capparè et al. showed, in their study, that 50 patients received immediately loaded prostheses supported by six implants (a total of 300 implants) with a fixture and prosthetic survival rate of 100% were observed [56].
After all, other authors asserted that definitive cement- and screw-retained ceramic restorations are highly predictable, biocompatible, and esthetically pleasing in full-arch rehabilitation [57]. According to these studies, our results showed that the immediately fixed rehabilitation of the mandible, with two axial and two distal implants, was a suitable procedure, reporting a total implant failure rate of 1.21%.
In contrast with a previous article [58] on systemic patients, in the present study, no smoker patients reported fewer failures than smoker ones; considering its limitations, further clinical trials should compare and analyze this finding.
Another bias is the potential of tissue healing. Indeed, in the review of Srinivasan [15], several biases are emphasized in the elderly population. Aging affects bone healing, therefore osseointegration, and it seems that oral biofilm is altered in aging [59].
In his article, Meyer attributed the possible reason to the fact that older people brush their teeth less and with less care, having a drop in visual and tactile perception and losing oral hygiene as a priority [60].
However, Muller et al. postulated that it is not related to age, but to personal hygiene, so implant rehabilitation should be limited to patients with good oral hygiene and in the absence of bad habits [61].
An overall nonlinear risk pattern of implant failure was observed in the recent study of Jemt which emphasized that middle-aged patients have more risks in implant rehabilitation than young and elderly patients [62]; however, this result may be related to a partial edentulousness of Cawood and Howell I and II classes [22].
Moreover, Kower [63] affirmed that dental rehabilitation in partially edentulous elderly patients showed comparable clinical and radiographic results as elderly patients treated in the edentulous jaw. In our study, no significant differences were reported between the younger and older patients, even if peri-implantitis affected younger ones. This is in part according to a recent systematic review [64], which found medium-high evidence that age is not related to peri-implantitis. Therefore, according to our results in full-arch rehabilitations, it could be hypothesized that age can be a secondary variable with respect to the oral hygiene status and bad habits of patients [65]. The null hypothesis was not rejected, except for peri-implantitis, which resulted statistically significantly more frequent in the YG than OG (p = 0.00031).

5. Conclusions

Within its limitations, the present study reported that immediate fixed mandibular full-arch rehabilitation is a viable procedure in elderly people equal to or more than 75 years of age.
Further studies are needed to evaluate with a longer follow-up period regarding the complications rate, in particular peri-implantitis.

Author Contributions

Conceptualization, E.F.G. and P.C.; methodology, P.C.; software, M.N.; validation, E.F.G. and P.C.; formal analysis, G.T.; investigation, G.T.; resources, B.D.; data curation, M.N.; writing—original draft preparation, B.D.; writing—review and editing, G.T.; visualization, M.N.; supervision, G.T. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Ethics Committee of Vita-Salute San Raffaele University, Dental School Department of Dentistry IRCCS San Raffaele Hospital, Milan, 20132, Italy. The ethics committee approval number is 190/INT/2021.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Ortman, J.M.; Velkoff, V.A.; Hogan, H. An Aging Nation: The Older Population in the United States; Current Population Report; U.S. Census Bureau: Washington, DC, USA, 2014; pp. 25–1140. [Google Scholar]
  2. Villa, A.; Polimeni, A.; Strohmenger, L.; Cicciù, D.; Gherlone, E.; Abati, S. Dental patients’ self-reports of xerostomia and associated risk factors. J. Am. Dent. Assoc. 2011, 142, 811–816. [Google Scholar] [CrossRef]
  3. Nota, A.; Abati, S.; Bosco, F.; Rota, I.; Polizzi, E.; Tecco, S. General Health, Systemic Diseases and Oral Status in Adult Patients with Coeliac Disease. Nutrients 2020, 12, 3836. [Google Scholar] [CrossRef] [PubMed]
  4. Corbella, S.; Agliardi, E.; Basso, M.; Romeo, D.; Testori, T.; Francetti, L. Management of dental patients taking anticoagulant drugs. Dent. Cadmos 2008, 76, 13–23. [Google Scholar]
  5. Roncati, M.; Polizzi, E.; Cingano, L.; Gherlone, E.F.; Lucchese, A. An oral health aid for disabled patients. Dent. Cadmos 2013, 81, 447–452. [Google Scholar] [CrossRef]
  6. Sannino, G.; Montemezzi, P.; Pantaleo, G.; Agliardi, E. Dental implants survival rate in controlled type i diabetic patients: A prospective longitudinal study with a 2-year follow-up. J. Biol. Regul. Homeost. Agents 2020, 34, 35–43. [Google Scholar]
  7. Tetè, G.; Polizzi, E.; D’orto, B.; Carinci, G.; Capparè, P. How to consider implant-prosthetic rehabilitation in elderly patients: A narrative review. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 119–126. [Google Scholar] [CrossRef]
  8. Hoeksema, A.R.; Visser, A.; Raghoebar, G.M.; Vissinik, A.; Meijer, H.J. Influence of Age on Clinical Performance of Mandibular Two-Implant Overdentures: A 10 Year Prospective Comparative Study. Clin. Implant Dent. Relat. Res. 2016, 18, 745–751. [Google Scholar] [CrossRef] [PubMed]
  9. Saldìas, M.P.; Feràndez, C.; Morgan, A.; Díaz, C.; Morales, D.; Jaña, F.; Gómez, A.; Silva, A.; Briceño, F.; Oyarzún, A.; et al. Aged blood factors decrease cellular responses associated with delayed gingival wound repair. PLoS ONE 2017, 12, e0184189. [Google Scholar] [CrossRef] [Green Version]
  10. Borgiani, E.; Figge, C.; Kruck, B.; Willie, B.M.; Duda, G.N.; Checa, S. Age-related changes in the mechanical regulation of bone healing are explained by altered cellular mechanoresponse. J. Bone Miner. Res. 2019, 34, 1923–1937. [Google Scholar] [CrossRef]
  11. Ciancaglini, R.; Gherlone, E.F.; Radaelli, G. Association between loss of occlusal support and symptoms of functional disturbances of the masticatory system. J. Oral. Rehabil. 1999, 26, 248–253. [Google Scholar] [CrossRef]
  12. Ciancaglini, R.; Gherlone, E.F.; Redaelli, S.; Radaelli, G. The distribution of occlusal contacts in the intercuspal position and temporomandibular disorder. J. Oral. Rehabil. 2002, 29, 1082–1090. [Google Scholar] [CrossRef]
  13. Lucchese, A.; Manuelli, M.; Bassani, L.; Albertini, P.; Matarese, G.; Perillo, L.; Gastaldi, G.; Gherlone, E.F. Fiber reinforced composites orthodontic retainers. Minerva Stomatol. 2015, 64, 323–333. [Google Scholar] [PubMed]
  14. Park, J.C.; Baek, W.S.; Choi, S.H.; Cho KS et Jung, U.W. Long-term outcomes of dental implants placed in elderly patients: A retrospective clinical and radiographic analysis. Clin. Oral Implant. Res. 2016, 28, 186–191. [Google Scholar] [CrossRef] [PubMed]
  15. Srinivasan, M.; Meyer, S.; Mombelli, A.; Muller, F. Dental implants in the elderly population: A systematic review and meta-analysis. Clin. Oral Implant. Res. 2017, 28, 920–930. [Google Scholar] [CrossRef] [PubMed]
  16. Visser, A.; de Baat, C.; Hoeksema, A.R.; Vissink, A. Oral implants in elderly patients: A problem or a blessing? Gerodontology 2011, 28, 76–80. [Google Scholar] [CrossRef]
  17. Kondell, P.A.; Nordenram, A.; Landt, H. Titanium implants in the treatment of edentulousness: Influence of patients’ age on prognosis. Gerodontics 1988, 4, 280–284. [Google Scholar]
  18. Gastaldi, G.; Gherlone, E.; Manacorda, M.; Ferrini, F.; Bova, F.; Vinci, R.; Cattoni, F. A 3-D CAD/CAM technique in full-arch implant supported rehabilitations: The Virtual Implant-Prosthetic Procedure (VIPP Technique). A prospective longitudinal study. J. Osseointegr. 2018, 10, 2–10. [Google Scholar]
  19. Cattoni, F.; Teté, G.; Calloni, A.M.; Manazza, F.; Gastaldi, G.; Capparè, P. Milled versus moulded mock-ups based on the superimposition of 3D meshes from digital oral impressions: A comparative in vitro study in the aesthetic area. BMC Oral Health 2019, 19, 230. [Google Scholar] [CrossRef]
  20. Cattoni, F.; Mastrangelo, F.; Gherlone, E.F.; Gastaldi, G. A New Total Digital Smile Planning Technique (3D-DSP) to Fabricate CAD-CAM Mockups for Esthetic Crowns and Veneers. Int. J. Dent. 2016, 2016, 6282587. [Google Scholar] [CrossRef] [Green Version]
  21. Gherlone, E.F.; Ferrini, F.; Crespi, R.; Gastaldi, G.; Capparé, P. Digital impressions for fabrication of definitive “All-on-four” restorations. Implant. Dent. 2015, 24, 125–129. [Google Scholar] [CrossRef]
  22. Del Fabbro, M.; Pozzi, A.; Romeo, D.; de Araújo Nobre, M.; Agliardi, E. Outcomes of fixed full-arch rehabilitations supported by tilted and axially placed implants: A systematic review and meta-analysis. Int. J. Oral Maxillofac. Implant. 2022, 37, 1003–1025. [Google Scholar] [CrossRef] [PubMed]
  23. Manazza, F.; La Rocca, S.; Nagni, M.; Chirico, L.; Cattoni, F. A simplified digital workflow for the prosthetic finishing of implant rehabilitations: A case report. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 87–97. [Google Scholar] [CrossRef] [PubMed]
  24. Ferrari Cagidiaco, E.; Carboncini, F.; Parrini, S.; Doldo, T.; Nagni, M.; Nuti, N.; Ferrari, M. Functional implant prosthodontic score of a one-year prospective study on three different connections for single-implant restorations. J. Osseointegr. 2018, 10, 130–135. [Google Scholar] [CrossRef]
  25. Cappare, P.; Ferrini, F.; Mariani, G.; Nagni, M.; Cattoni, F. Implant rehabilitation of edentulous jaws with predominantly monolithic zirconia compared to metal-acrylic prostheses: A 2-year retrospective clinical study. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 99–112. [Google Scholar] [CrossRef] [PubMed]
  26. Merlone, A.; Tetè, G.; Cantile, N.; Manacorda, M.; Cattoni, F. Minimally invasive digital implant-prosthetic procedure in “all on 4” rehabilitation in patients with special needs: A three-year follow-up. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 71–85. [Google Scholar] [CrossRef] [PubMed]
  27. Malò, P.; De Arauijo Norbre, M.; Lopes, A.; Ferro, A.; Botto, J. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin. Implant. Dent. Relat. Res. 2019, 21, 565–577. [Google Scholar] [CrossRef]
  28. Agliardi, E.; Panigatti, S.; Clerico, M.; Villa, C.; Malo, P. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: Interim results of a single cohort prospective study. Clin. Oral. Implant. Res. 2010, 21, 459–465. [Google Scholar] [CrossRef]
  29. Polizzi, E.; D’orto, B.; Tomasi, S.; Tetè, G. A micromorphological/microbiological pilot study assessing three methods for the maintenance of the implant patient. Clin. Exp. Dent. Res. 2021, 7, 156–162. [Google Scholar] [CrossRef]
  30. Cattoni, F.; Chirico, L.; Cantile, N.; Merlone, A. Traditional prosthetic workflow for implant rehabilitations with a reduced number of fixtures: Proposal of a protocol. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 31–40. [Google Scholar] [CrossRef]
  31. Cattoni, F.; Chirico, L.; Merlone, A.; Manacorda, M.; Vinci, R.; Gherlone, E.F. Digital Smile Designed Computer-Aided Surgery versus Traditional Workflow in “All on Four” Rehabilitations: A Randomized Clinical Trial with 4-Years Follow-Up. Int. J. Environ. Res. Public Health 2021, 18, 3449. [Google Scholar] [CrossRef]
  32. Manacorda, M.; Poletti de Chaurand, B.; Merlone, A.; Tetè, G.; Mottola, F.; Vinci, R. Virtual Implant Rehabilitation of the Severely Atrophic Maxilla: A Radiographic Study. Dent. J. 2020, 8, 14. [Google Scholar] [CrossRef] [Green Version]
  33. Di Nisio, C.; Zizzari, V.L.; Zara, S.; Falconi, M.; Teti, G.; Tetè, G.; Nori, A.; Zavaglia, V.; Cataldi, A. RANK/RANKL/OPG signaling pathways in necrotic jaw bone from bisphosphonate-treated subjects. Eur. J. Histochem. 2015, 59, 2455. [Google Scholar] [CrossRef] [Green Version]
  34. Trimarchi, M.; Rampi, A.; Vinciguerra, A.; Polizzi, E.; Policaro, N.S.; Gastaldi, G. Palatal prosthetic rehabilitation in patients affected by cocaine-induced midline destructive lesions. J. Biol. Regul. Homeost. Agents 2020, 34 (Suppl. S3), 59–68. [Google Scholar] [PubMed]
  35. Polizzi, E.; Tetè, G.; Targa, C.; Salviato, B.; Ferrini, F.; Gastaldi, G. Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy. Int. J. Environ. Res. Public. Health 2020, 17, 6192. [Google Scholar] [CrossRef] [PubMed]
  36. Cawood, J.I.; Howell, R.A. A Classification of the edentulous jaws. Int. J. Oral Maxillofac. Surg. 1988, 17, 232–236. [Google Scholar] [CrossRef] [PubMed]
  37. Lekholm, U.; Zarb, G.A. Patient selection. In Tissue Integrated Prostheses. Osseointegration in Clinical Dentistry; Branemark, P.I., Zarb, G.A., Albrektsson, T., Eds.; Quintessence: Chicago, IL, USA, 1985; pp. 199–209. [Google Scholar]
  38. Capparè, P.; D’ambrosio, R.; De Cunto, R.; Darvizeh, A.; Nagni, M.; Gherlone, E. The usage of an air purifier device with HEPA 14 filter during dental procedures in COVID-19 pandemic: A randomized clinical trial. Int. J. Environ. Res. Public Health 2022, 19, 5139. [Google Scholar] [CrossRef] [PubMed]
  39. Polizzi, E.; Tetè, G. Manual vs. Mechanical Oral Hygiene Procedures: Has the Role of the Dental Hygienist in Phase 2 Post-lockdown Really Changed? Oral Health Prev. Dent. 2020, 18, 1031–1037. [Google Scholar] [CrossRef]
  40. Maló, P.; de Araújo Nobre, M.; Lopes, A.; Ferro, A.; Gravito, I. All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level. Clin. Implant. Dent. Relat. Res. 2015, 17 (Suppl S2), e531–e541. [Google Scholar] [CrossRef]
  41. Sannino, G.; Capparé, P.; Montemezzi, P.; Alfieri, O.; Pantaleo, G.; Gherlone, E. Postoperative bleeding in patients taking oral anticoagulation therapy after ‘All-on-four’ rehabilitation: A case-control study. Int. J. Oral Implantol. 2020, 13, 77–87. [Google Scholar]
  42. D’Orto, B.; Polizzi, E.; Nagni, M.; Tetè, G.; Capparè, P. Full Arch Implant-Prosthetic Rehabilitation in Patients with Type I Diabetes Mellitus: Retrospective Clinical Study with 10 Year Follow-Up. Int. J. Environ. Res. Public Health 2022, 19, 11735. [Google Scholar] [CrossRef]
  43. Tetè, G.; Cattoni, F.; Polizzi, E. Anti-discoloration system: A new chlorhexidine mouthwash. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 113–118. [Google Scholar] [CrossRef] [PubMed]
  44. Tetè, G.; D’orto, B.; Ferrante, L.; Polizzi, E.; Cattoni, F. Role of mast cells in oral inflammation. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 65–70. [Google Scholar] [CrossRef] [PubMed]
  45. Angiero, F.; Ugolini, A.; Cattoni, F.; Bova, F.; Blasi, S.; Gallo, F.; Cossellu, G.; Gherlone, E. Evaluation of bradykinin, VEGF, and EGF biomarkers in gingival crevicular fluid and comparison of PhotoBioModulation with conventional techniques in periodontitis: A split-mouth randomized clinical trial. Lasers Med. Sci. 2020, 35, 965–970. [Google Scholar] [CrossRef]
  46. Mastrangelo, F.; Dedola, A.; Cattoni, F.; Ferrini, F.; Bova, F.; Tatullo, M.; Gherlone, E.; Lo Muzio, L. Etiological periodontal treatment with and without low-level laser therapy on IL-1β level in gingival crevicular fluid: An in vivo multicentric pilot study. J. Biol. Regul. Homeost. Agents 2018, 32, 425–431. [Google Scholar] [PubMed]
  47. Cattoni, F.; Pappalardo, S.; Vettese, P.; Santoro, G.; Gherlone, E. The laser technology in impression-taking technique and soft tissues management La tecnologia laser nel rilievo delle impronte in protesi fissa e nella gestione dei tessuti molli. PROtech 2007, 8, 17–27. [Google Scholar]
  48. Tetè, G.; Sacchi, L.; Camerano, C.; Nagni, M.; Capelli, O.; Giuntoli Vercellin, S.; La Rocca, G.; Polizzi, E. Management of the delicate phase of the temporary crown: An in vitro study. J. Biol. Regul. Homeost. Agents 2020, 34 (Suppl. S3), 69–80. [Google Scholar]
  49. Tecco, S.; Cattoni, F.; Darvizeh, A.; Bosco, F.; Sanci, V.; Nota, A.; Gastaldi, G.; Gherlone, E.F. Evaluation of Masticatory Muscle Function Using Digital versus Traditional Techniques for Mockup Fabrication: A Controlled Prospective Study. Appl. Sci. 2020, 10, 6013. [Google Scholar] [CrossRef]
  50. Cattoni, F.; Tetè, G.; Uccioli, R.; Manazza, F.; Gastaldi, G.; Perani, D. An fMRI Study on Self-Perception of Patients after Aesthetic Implant-Prosthetic Rehabilitation. Int. J. Environ. Res. Public Health 2020, 17, 588. [Google Scholar] [CrossRef] [Green Version]
  51. Cattoni, F.; Merlone, A.; Broggi, R.; Manacorda, M.; Vinci, R. Computer-assisted prosthetic planning and implant design with integrated digital bite registration: A treatment protocol. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 11–29. [Google Scholar] [CrossRef]
  52. Rebba, B.; Merlone, A.; Cantile, N.; Manazza, F.; Cattoni, F. Digital smile planning technique applied to prosthetic rehabilitation of dental esthetic area: A case report. J. Biol. Regul. Homeost. Agents 2021, 35 (Suppl. S1), 1–9. [Google Scholar] [CrossRef]
  53. Cheung, M.C.; Hopcraft, M.S.; Darby, I.B. Dental Implant Hygiene and Maintenance Protocols: A survey of oral health practitioners in Australia. J. Dent. Hyg. 2021, 95, 25–35. [Google Scholar]
  54. Al-Fahd, A.A. Old age alone may not be a risk factor for dental implant failure. J. Evid. Based Dent. Pract. 2016, 16, 176–178. [Google Scholar] [CrossRef]
  55. Malò, P.; de Araujo Nobre, M.; Lopes, A.; Ferro, A.; Nunes, M. The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: A longitudinal study with 5–13 years of follow-up. Clin. Implant. Relat. Res. 2019, 21, 538–549. [Google Scholar] [CrossRef]
  56. Gherlone, E.F.; Capparé, P.; Pasciuta, R.; Grusovin, M.G.; Mancini, N.; Burioni, R. Evaluation of resistance against bacterial microleakage of a new conical implant-abutment connection versus conventional connections: An in vitro study. New Microbiol. 2016, 39, 59–66. [Google Scholar]
  57. Crespi, R.; Capparè, P.; Polizzi, E.M.; Gherlone, E.F. Tissue remodeling after bone expansion in grafted and ungrafted sockets. Int. J. Oral Maxillofac. Implant. 2014, 29, 699–704. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  58. Montemezzi, P.; Ferrini, F.; Pantaleo, G.; Gherlone, E.; Capparè, P. Dental implants with different neck design: A prospective clinical comparative study with 2-year follow-up. Materials 2020, 13, 1029. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  59. Pandey, C.; Rokaya, D.; Bhattarai, B.P. Contemporary Concepts in Osseointegration of Dental Implants: A Review. Biomed. Res. Int. 2022, 2022, 6170452. [Google Scholar] [CrossRef]
  60. Meyer, S.; Giannopoulou, C.; Courvoisier, D.; Schimmel, M.; Müller, F.; Mombelli, A. Experimental mucositis and experimental gingivitis in persons aged 70 or over. Clinical and biological response. Clin. Oral Implant. Res. 2017, 28, 1005–1012. [Google Scholar] [CrossRef] [PubMed]
  61. Muller, F.; Duvernay, E.; Loup, A.; Vazquez, L.; Hermann, F.R.; Schimmel, M. Implant-supported Mandibular Overdentures in very Old Adults: A Randomuzed Controlled Trial. J. Dent. Res. 2013, 92 (Suppl. S12), 154S–160S. [Google Scholar] [CrossRef] [PubMed]
  62. Jemt, T. Implant failures and age at the time of surgery: A retrospective study on implant treatment in 2915 partially edentulous jaws. Clin. Implant Dent. Relat. Res. 2019, 21, 686–692. [Google Scholar] [CrossRef]
  63. Kowar, J.; Eriksson, A.; Jemt, T. Fixed implant-supported prostheses in elderly patients: A 5-years retrospective comparison between partially and completely edentulous patients aged 80 years or older at iumplant surgery. Clin. Implant Dent. Relat. Res. 2013, 15, 37–46. [Google Scholar] [CrossRef] [PubMed]
  64. Dreyer, H.; Grischke, J.; Tiede, C.; Eberhard, J.; Schweitzer, A.; Toikkanen, S.E.; Glöckner, S.; Krause, G.; Stiesch, M. Epidemiology and risk factors of peri-implantitis: A systematic review. J. Periodontal Res. 2018, 53, 657–681. [Google Scholar] [CrossRef] [PubMed]
  65. Tecco, S.; Grusovin, M.G.; Sciara, S.; Bova, F.; Pantaleo, G.; Capparé, P. The association between three attitude-related indexes of oral hygiene and secondary implant failures: A retrospective longitudinal study. Int. J. Dent. Hyg. 2018, 16, 372–379. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Implants diameters and lengths.
Table 1. Implants diameters and lengths.
Mandible n = 264
Length 13 mmLength 15 mmLength 11 mm
upright n = 132diameter 3.3 mm31028
diameter 3.8 mm44029
tilted n = 132diameter 3.3 mm28290
diameter 3.8 mm31440
Table
Table 2. Systemic disease for the groups; COPD = chronic obstructive pulmonary disease.
Table 2. Systemic disease for the groups; COPD = chronic obstructive pulmonary disease.
Disease# Patients YG# Patients OG
Hypertension818
Diabetes411
Osteoporosis24
Heart failure25
COPD13
Cerebrovascular disease03
Table
Table 3. Details of implant failures.
Table 3. Details of implant failures.
# PatientGroupPositionReason of FailureTime of Failure from PlacementSmokerSystemic Diseases
1YGright mesialprimary infection1 monthNoNo
2OGright distalprimary infection2 monthsNoHypertension and diabetes
3YGleft mesialPeri-implantitis4 years and 3 monthsNoHypertension
Table
Table 4. Marginal bone loss for the younger group (YG) and older group (OG).
Table 4. Marginal bone loss for the younger group (YG) and older group (OG).
Bone LossYGOG
6 months (mm)0.61 ± 0.720.62 ± 0.54
1 year (mm)0.84 ± 0.960.80 ± 0.79
2 years (mm)0.86 ± 0.760.82 ± 0.71
3 years (mm)0.91 ± 0.740.86 ± 0.98
4 years (mm)1.02 ± 1.010.90 ± 1.01
5 years (mm)1.05 ± 0.850.93 ± 1.01
6 years (mm)1.10 ± 0.641.03 ±1.04
7 years (mm)1.12 ± 0.911.04 ± 1.00
Table
Table 5. Implant failure, prosthetic failure, biological, and mechanical complications.
Table 5. Implant failure, prosthetic failure, biological, and mechanical complications.
# ComplicationsRate
Implant failure41.52%
Prosthetic failure00
Fixture fracture00
Peri-implantitis72.65%
Provisional prosthesis fracture46.01%
Episode of pus00
Pain00
Paresthesia00
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Capparè, P.; Tetè, G.; D’Orto, B.; Nagni, M.; Gherlone, E.F. Immediate Loaded Full-Arch Mandibular Rehabilitations in Younger vs. Elderly Patients: A Comparative Retrospective Study with 7-Year Follow-Up. J. Clin. Med. 2023, 12, 4524. https://doi.org/10.3390/jcm12134524

AMA Style

Capparè P, Tetè G, D’Orto B, Nagni M, Gherlone EF. Immediate Loaded Full-Arch Mandibular Rehabilitations in Younger vs. Elderly Patients: A Comparative Retrospective Study with 7-Year Follow-Up. Journal of Clinical Medicine. 2023; 12(13):4524. https://doi.org/10.3390/jcm12134524

Chicago/Turabian Style

Capparè, Paolo, Giulia Tetè, Bianca D’Orto, Matteo Nagni, and Enrico Felice Gherlone. 2023. "Immediate Loaded Full-Arch Mandibular Rehabilitations in Younger vs. Elderly Patients: A Comparative Retrospective Study with 7-Year Follow-Up" Journal of Clinical Medicine 12, no. 13: 4524. https://doi.org/10.3390/jcm12134524

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop