Single implant therapy with todays technologies is a routine intervention and treatment option, and can considered a low-risk treatment for most patients and age groups, depending on general health and local tissue condition.
In most cases a single implant treatment will be selected by the patient for the esthetic potential and the feel like a natural tooth in comparison to a bridge treatment splinting teeth together. Also patients may prefer to not have cut down the adjacent teeth, and may consider implant treatment as 'lower invasive' in comparison to a bridge preparation even in light of the surgical treatment component. This may be especially important in a - often younger - patient group with sound, caries-free teeth, and high expectations to an esthetic, youthful and healthy appearance and quality of life aspects.
Unless for exceptions, implant based therapy cannot be generally recommended as long as the juvenile skeletal growth is going on. As a general rule implant treatment should not be performed in patients younger than approximately 20 years of age, depending on skeletal growth and gender. In female patients this age limit can be set slightly lower. For treatment needs of single missing teeth before this age, consider temporary solutions for example with removable prosthesis (flippers) or adhesive bridges (Maryland type).
In all but especially elderly patients interaction of existing diseases and medication with the implant treatment needs to be thorougly evaluated. Changes in the external appearance and shape of the jaws will also be accompanied by osseous metabolic changes. Cellular activity of the bone as well as neoangiogenesis is clearly reduced with advanced age. Bone healing is consequently substantially prolonged in elderly patients. As a result, the number of bone-implant surface contacts tends to decrease with increasing age. However, even advanced age has not been shown to be a risk factor for implant failure.
If possible, all procedures and interventions should be minimally invasive and implant healing and integration times are to be extended. For bone augmentation procedures prolonged healing times should definitely be observed. Prosthetic superstructure should allow for convenient oral hygiene in order to compensate for any age-related loss of manual dexterity or general frailty.
Upon appropriate observation of these guidelines the prognosis for the implants will be similar to the prognosis for “standard patients” (Fig 3).
In treatment of frail patients it needs to be evaluated, if they are able to manage the compliance, aftercare and maintenance requirements involved with implant treatment. In case of doubt an alternative treatment should be considered.