CASE PresENTATION

CLINICAL CASE OF ORAL REHABILITATION OF DELETE TEETH FOR

OLD PATIENT
Smtrea Oana1, Ghergic Doina Lucia1, Comneanu Raluca Monica1, Andreescu Claudia1,
Barbu Horia Mihail1, Hineal Cristina1
1

Faculty of Medicine and Dental Medicine, University Titu Maiorescu, Bucharest. Discipline of Dental
Prosthetics
Address for correspondence:
doinaghergic@yahoo.com
Received: 10.12.2010
Accepted: 01.05.2011
Med Con June 2011 Vol 6, No 2, 103108

Abstract
Missing of lateral teeth, molars and/or
premolars is a frequent situation for people over
65 years-old. Rehabilitation of this edentulous
area is a challenge for dental practitioner in order
to fulfil physiologic, masticatory and aesthetics
demands. This paper present a case of free end
span restored with dental implants.
Keywords: free end span, old patient,
implants
Introduction
The proportion of the elderly out of the
population is increasing. The prosthetic needs
and demands are different for this group of
population comparative with younger cohorts.
Regarding prosthetic treatment, fixed alternative
is much more attractive than mobile because
adaptation is much easier. Oral rehabilitation
with implants cannot be omitted from
therapeutically arsenal nowadays. It is indicated
for cooperative and motivated patients with
favourable local condition and good health,
without age limit. The contraindications are
represented by: frail patients, neuro-psychic
disease and poor oral hygiene.

Objective of study
This paper presents an example of oral
rehabilitation with dental implants for a patient
over 65 years-old.
Material and method
The patient had at maxillary edentulous Class
I Kennedy, and at mandible presented edentulous
class III Kennedy, partly prosthesis.
The next protocol was followed:
clinical and paraclinical examination,
establishing treatment plan,
preliminary treatments,
surgical stage,
postoperative follow-up,
prosthetic stage,
maintenance.
Results
This case presents a 73 years-old patient with
good health and adequate oral hygiene, which
comes to a dental office for replacing an old
cantilevered bridge on the right side of the maxillary.
After carefully clinical and radiological examination
(Figure 1) and evaluation of biological parameters,
the following treatment was established:

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CASE PRESENTATION

Figure 1. Patient status ortopantomography (Ortopantomograma pacientului la

prezentare)
removing the old bridge 1.3., 1.4., 1.5., 1.6.
temporary crown on canine 1.3.
immediate implantation for 1.4. and late
implantation with direct sinus lifts for 1.5.
porcelain fused to metal crown for 1.3.
and two unit bridge for 1.4. and 1.5.
Preliminary treatments consist of scaling and
root scaling, removing the old bridge and making
of temporary crown for 1.3.
Antibiotic prophylaxis was done with
amoxicillinum+acidum clavulanicum tablets of
1000 mg, one tablet each 8 hours for first two
days and 1 tablet each 12 hours for five days,
starting one day before surgery and continuing
six days after surgery.

Figure 2. Post-surgery X-ray (Aspectul radiologic

imediat postoperator)
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Surgery consists of 1.4. extraction and

immediate implantation (D 3.7 and L 14) and
1.5. late implantation (D 3.7 and L 12) with
direct sinus lift with bone condensation without
bone grafting (Figure 2) in one stage.
6 months after surgery endooseous implants
were exposed, fixed healing caps (Figure 3) and
started prosthetic restoration. In the same stage
was done porcelain fused to metal crown for 1.3.
and two unit porcelain fused to metal bridge for
implants (Figure 4), assuring canine guidance in
lateral movement and disocclusion of implant
support prosthesis. Clinical aspect (Figure 5) and
radiologic aspect (Figure 6) of fixed implant
supported prosthesis reveal good aesthetics, osseo
integration of implants, and evolution of sinusal
floor and passive fit of bridge to implants.
Discussion
According to Misch C.E. [1], oral
rehabilitation with dental implants represents
third dentition, which aims to restore mastication,
phonation and physiognomy in order to maintain
comfort and improve quality of life. Although
not limited to the aged population, oral implants
represent a tremendous potential in functionally
restoring the dentition of elderly people [2]. The
need for increasing subjective chewing comfort is
expressed often and may represent the major
indication for the installation of oral implants
[3]. Long-term results for fixed prostheses
supported by implants are similar for elderly and

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CASE PRESENTATION

Figure 3. Healing caps, five days after implants

exposure (Cilindrii de vindecare la cinci zile dup
descoperirea implanturilor)

Figure 4. Prosthetic abutments (Bonturile protetice

nurubate n implanturi)

Figure 5. Fixed prosthesis clinical aspect (Aspectul

clinic cu lucrrile cimentate)

Figure 4. Fixed implant-supported prostheses - Xrays (Imaginea de control radiologic a implanturilor protezate)

adults subjects and implants which support

cantilevered fixed prostheses have a rate of
survival of 100% after five years for aged
population [5].
In this case, after careful evaluation of the
patients needs for aesthetics and masticatory
function, it is decided to replace lost occlusal
units. The prosthetic alternatives are: removable
partial denture and cemented bridge on
endoosseous implants. The choice of prosthetic
treatment depends on topography, number and
quality of remaining teeth, quantity and quality
of bone and patients financial possibilities. The
treatment option was cemented bridge supported

by two implants which restore premolar area and

accomplish comfort, aesthetics and masticatory
efficiency desired by patient.
Conclusions
Treatment with dental implants can be
predictable and safe for elderly. Senior patients
who are medically stable are suitable candidates
for osseo integrated implant surgery, which
facilitates oral function, comfort, and quality of
life. This paper supports the conclusion that
dental implants can be successfully placed and
restored with fixed implant-supported prostheses
for elderly people.

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CASE PRESENTATION

CAZ CLINIC DE REABILITARE ORAL A UNEI EDENTAII TERMINALE

LA O PERSOAN DE VRSTA A TREIA
Rezumat
Pierderea dinilor laterali molari i/sau
premolari este o situaie ntlnit frecvent la
persoanele de peste 65 de ani. Protezarea acestei
edentaii pune adesea probleme n ncercarea de
a satisface doleanele funcionale, masticatorii i
estetice ale pacienilor. Acest articol prezint
protezarea unei edentaii terminale cu ajutorul
implanturilor endoosoase la o pacient de 73 ani.
Cuvinte cheie: edentaie terminal, vrsta a
treia, implanturi
Introducere
Numrul persoanelor de vrsta a treia este n
continu cretere. Nevoile i cerinele protetice
ale acestui grup populaional difer fa de
celelalte grupe de vrst. n ceea ce privete
tratamentul protetic varianta fix este o
alternativ mult mai atrgtoare comparativ cu
varianta mobil deoarece adaptarea este mult mai
uoar. n zilele noastre reabilitarea cu ajutorul
implanturilor nu poate fi exclus din arsenalul
terapeutic. Aceast variant de tratament este
indicat pacienilor cooperani i motivai, cu
condiii locale favorabile i cu o stare bun de
sntate, fr limit de vrst. Contraindicaiile
sunt reprezentate de pacieni decompensai, boli
neuro-psihice i igien oral necorespunztoare.
Obiectivul studiului
Acest articol prezint un exemplu de
reabilitare oral cu ajutorul implanturilor dentare
la o persoan de vrsta a treia.
Material i metod
La maxilar pacienta prezenta edentaie de
clasa I Kennedy cu o modificare, iar la mandibul
prezenta o edentaie de clasa a III-a Kennedy,
parial protezate.
Protocolul de tratament este urmtorul:
examenul clinic i paraclinic al pacientului,
stabilirea planului de tratament,
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efectuarea tratamentelor pregtitoare,

inserarea implanturilor,
control postoperator i monitorizarea
pacientului,
protezarea implanturilor,
dispensarizare.
Rezultate
Pacientul este o persoan de sex feminin de
73 de ani cu stare general bun i igien oral
corespunztoare, care se prezint la medic pentru
nlocuirea unei puni metalo-acrilice de pe
hemiarcada superioar dreapt. n urma
examenului clinic, radiologic (Figura 1) i al
examenelor de laborator se stabilete urmtorul
plan de tratament:
ablaia punii 1.3., 1.4., 1.5., 1.6.
coroan provizorie pe caninul 1.3.
implantare imediat 1.4. i implantare
tardiv cu sinus-lift pe cale alveolar 1.5.
coroan solo 1.3. i dou coroane solida
rizate pe implanturi 1.4., 1.5.
Tratamentele pregtitoare au constat n
igienizare profesional, ndeprtarea vechii
lucrri protetice i realizarea unei coroane
provizorii pentru 1.3.
Profilaxia cu antibiotice s-a realizat cu
amoxicillinum+acidum clavulanicum, tablete de
1000 mg, astfel: 1 tablet la 8 ore primele 2 zile,
urmtoarele 5 zile 1 tablet la 12 ore, ncepnd
din ziua premergtoare interveniei i continund
6 zile dup operaie.
Pentru 1.4. s-a realizat extracie i implantare
imediat (D 3,7 i L 14), iar pentru 1.5. s-a
realizat implantare tardiv (D 3,7 i L 12) cu
sinus lift pe cale alveolar prin osteocondensare
fr adiie de os (Figura 2), ntr-o singur etap
chirurgical.
Dup 6 luni de la intervenia chirurgical
implanturile au fost descoperite, s-au aplicat
capele de vindecare (Figura 3) i s-a nceput
reconstituirea protetic. n aceai etap a fost

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realizat coroana metalo-ceramic pe canin, ct i

coroanele metalo-ceramice solidarizate pe
implanturi (Figura 4), astfel nct n micarea de
lateralitate s se obin ghidaj canin i dezocluzia
restaurrilor pe implanturi. Aspectul clinic
(Figura 5) i radiologic al restaurrii implantopurtate (Figura 6) arat aspectul estetic
satisfctor, integrarea implanturilor, evoluia
conturului sinusal i adaptarea pasiv a lucrrii la
implanturi.
Discuii
Dup Misch C.E. [1], tratamentul implantoprotetic reprezint a treia dentiie, care are ca
obiective restaurarea funciei masticatorii, a
fonaiei i a zionomiei n vederea meninerii
strii de sntate a pacientului, pentru asigurarea
confortului acestuia i mbuntirea calitii
vieii. Nu exist limit de vrst n ceea ce privete
tratamentul implanto-protetic, iar implanturile
dentare au un potenial extraordinar n restaurarea
funcional a dentiiei persoanelor n vrst [2].
Cerina pentru un confort masticator subiectiv
exprimat de ctre pacieni poate reprezenta
principala indicaie a implanturilor dentare [3].
Rezultatele pe termen lung ale lucrrilor protetice
fixe realizate pe implanturi la pacienii vrstnici
sunt similare cu cele ale pacienilor aduli [4], iar
implanturile care susin lucrrile fixe cu extensie
au o rat de supravieuire de 100% dup cinci
ani la subiecii n vrst [5].
n cazul de fa dup evaluarea nevoilor
masticatorii i estetice ale pacientei s-a decis
nlocuirea
unitilor
ocluzale
pierdute,
alternativele de tratament fiind proteza parial
mobil i puntea cimentat pe implanturi.
Alegerea planului de tratament depinde de
topografia, numrul i calitatea dinilor restani,

de cantitatea i calitatea osului maxilar, precum i

de posibilitile financiare ale pacientului. S-a
optat pentru o punte cimentat pe implanturi
care reface zona premolar, care asigur confortul,
fizionomia, dar i eficiena masticatorie solicitat
de pacient.
Concluzii
Tratamentul cu implanturi dentare poate fi
predictibil i sigur pentru vrstnici. Pacienii de
vrsta a treia care sunt stabili din punct de vedere
medical sunt candidai potrivii pentru
implanturile dentare care faciliteaz funcio
nalitatea cavitii orale, confortul i calitatea
vieii. Acest articol susine argumenteaz faptul
c implanturile dentare pot fi folosite cu succes la
persoanele de vrsta a treia i pot fi restaurate cu
lucrri fixe.
References (Referine)
1. Misch C.E. Contemporary Implant Dentistry. 3rd
Edition. Mosby Elsevier 2008.
2. Baart C. Success of dental implants in elderly people
- a literature review. Gerodontology. 2000
Jul;17(1):45-8.
3. Holm-Pedersen P, Le H. Textbook of Geriatric
Dentistry. Munksgaard 1996.
4. Engfors I, Ortorp A, Jemt T. Fixed implantsupported prostheses in elderly patients: a 5-year
retrospective study of 133 edentulous patients older
than 79 years. Clin Implant Dent Relat Res.
2004;6(4):190-8.
5. Gallucci GO, Doughtie CB, Hwang JW,
Fiorellini JP, Weber HP. Five-year results of fixed
implant-supported rehabilitations with distal
cantilevers for the edentulous mandible. Clin Oral
Implants Res. 2009 Jun;20(6):601-7.

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