CASE LETTER

Simplifying the Implant Treatment

Plan for an Elderly Patient
Marcelo Munhóes Romano*
Mario Sergio Soares
Gisele Ebling Artes
Daniela Giunte Yoshida
Flávio Eduardo Guillin Perez
Carlos Alberto Adde

INTRODUCTION tion with PRP was planned and proposed to

avoid subjecting the patient to sinus lifting

I
n the search for a better lifestyle and
increased life expectancy, more and surgery and to preserve the remaining tooth
more elderly are seeking dental treat- and the residual ridge; however, the team
ment. However, many of these patients explained that greater load would be gener-
present systemic compromise that could ated on these if they received only PRPs.
affect the success and maintenance of the CASE REPORT
proposed therapy. In such cases, simple pro-
A 71-year-old male patient with controlled
posals, such as partial removable prostheses
hypertension and presenting with dental
(PRPs), must be used. PRPs are widely used,
phobia inquired about dental implants, seek-
especially when conditions for rehabilitation
ing to improve both esthetics and function.
with a fixed prosthesis attached to implants
During the planning stage, the need for
are not favorable.1
surgery to achieve maxillary sinus lifting was
In one study,2 10 patients were rehabil-
observed if rehabilitation with a fixed prosthesis
itated with inferior PRPs supported by im-
on implants was chosen (Figures 1 and 2).
plants in the posterior region; results show
However, following the clinical examination
increased satisfaction in all patients, minimal
and according to patient history, planning was
wear of the component, absence of exces-
directed toward simplified rehabilitation, also
sive bone loss, and periodontal health after
involving implants, but associated with PRP.
1 year of rehabilitation.
This solution rehabilitated the patient within his
Literature describing the combination of
functional and esthetic expectations without
PPRs and implants is scarce and is based
subjecting him to greater stress.
mainly on clinical reports of posterior im-
Following initial procedures of restorative
plants for distal extension with PRPs.3,4 In this
care, the surgical implantology step was
case, rehabilitation with fixed prostheses and
initiated, during which the region of missing
implants was proposed to the patient, who
elements 15, 22, 24, 36, and 46 received Cone
required surgically guided bone regeneration
Morse implants. After 4 months, implanted
through subantral graft or PRPs, but the
regions were reopened with placement of the
patient declined both proposals. Following
healings. Then the prosthetic components
this, rehabilitation with implants in conjunc-
were selected, highlighting the region of
*Corresponding author, e-mail: mmromano@usp.br
elements 24 and 25, which received o-ring
DOI: 10.1563/AAID-JOI-D-10-00078 abutment (Figure 3).

Journal of Oral Implantology 177

Implant Treatment for an Elderly Patient

FIGURES 1–4. FIGURE 1. Initial radiographic planning. FIGURE 2. Initial case condition. FIGURE 3. Placement of
o-ring abutments. FIGURE 4. Final radiographic condition.

DISCUSSION that he reported high levels of fear and

The proposed therapy considered the pa- anxiety. The treatment approach was pre-
tient’s complaint, his systemic framework, ventive, based on maintenance of blood
and his response to invasive events, given pressure without systemic risks to the

FIGURES 5–7. FIGURE 5. Case outcome. FIGURE 6. Clinical condition after 1 year. FIGURE 7. Radiograph after 1 year.

178 Vol. XXXVIII/No. Two/2012


patient, by not indicating surgery for maxil-
lary sinus lifting. The patient received 5
implants, and the top 2 retainers were PRP
o-rings (Figures 4 and 5).
In rehabilitation with PRPs, viscoelastic
tissue, alveolar mucosa, and teeth must be
properly evaluated because they serve as
support structures. When rehabilitation is
associated with osseointegrated implants,
which provide the support line between
these pillars and edentulous areas in classes I
and II of Kennedy situations, survival can be
compromised by functional overload.5 How-
ever, when implants are used only to retain
the PRP, the current consensus is that
support, retention, and stability of PPRs are
improved without overload and without the
need for conventional clips.
Follow-up of 1 year shows that the
impact of treatment was well absorbed by
the tissues, allowing the original treatment
plan to be maintained (Figures 6 and 7).
CONCLUSION
It was possible to establish a comfortable
situation, both esthetically and functionally,
Romano et al
without creating more fear and anxiety in the
patient, because greater intervention, such as
sinus lifting and grafting, was not required,
resulting in satisfactory treatment at a lower
cost with less stress and over a shorter time.
ABBREVIATION
PRP: partial removable prosthesis
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Journal of Oral Implantology 179