The Brazilian scenario on implant dentistry: a look into the near future

The dental implant patient gets older: what are the treament options now?

Certainly, Brazilian dental surgeons are worldwide considered as one of the most versatile, besides disparities on commercially available products, import tax policies (US$/BRL currency fluctuations), as well as the number of third-party health service providers covering varied fees.

Also, Implant Dentistry scores as the number one of all dental specialties. In this way, states like Sao Paulo, Minas Gerais and Rio de Janeiro found themselves in the first ranked three positions.

When one considers the overall national dental taskforce (e.g., hygienists, labs, technicians), according to the CFO (Federal Council in Dentistry), those figures almost reach 900 thousand collaborations.

Regarding Implant Dentistry, the number of certified specialists has jumped to more than 23 thousand professionals.

However, those numbers are not enough to counteract the real dental situation: from the last 2019 National Survey, the IBGE (Brazilian Institute of Geography and Statistics) highlights the number of completely edentulous persons still being very significant (near 44 million persons).

In addition, half of the middle-aged citizens continue to be oral invalids (completely edentulous).

Nowadays, the new challenge facing Brazilian implant dentistry is a double-edge sword: on the one hand, with the population pyramid finally changing upside down, more “dental update” is needed.

On the other hand, new implant placements and/or repair procedures on prosthetic devices are reaching the top of the most accessed services.

Your implant denture is like a car: periodic revisions are necessary

Mechanical pieces are exactly as they seem: no heart, no emotion. A screw breaks, an artificial tooth fractures, the color of your gingiva changes, and so the entire prosthesis wears out.

Normally, those outcomes happen in the short term when patients are trying to adjust, but complications in the long run are also possible.

The point is that dental implant surgery, when properly done, has become a safe procedure with minimal drawbacks. Then, people get used very soon to their treatments.

After that, as the human body “internalizes” it, the next days go unnoticed and regular checkups are frequently missed.

The older the prosthesis, the older the dental implant?

The answer to this question is: in a different way.

Over a lifetime, prosthodontic and maintenance services will respond for most of the chairside and reimbursements. Obviously, dental implant corrosion/fracture occurrences are possible, but in a lesser proportion (less than 5% in general).

Another aspect is that older implant patients have systems with the first developments launched by seminal companies.

The trade-off is simple: your local repair shop (the stock part division at your dental office) must be ready for every type of dental implant connection (e.g., hexagonal, Morse, tapered, internal lobular, star-type) that has flooded the market in the last 30-40 years.

At the same time, the importance of preventive/supportive programs for people with dental implants is on every clinician´s agenda; however, what a patient needs to save for dental implant urgency sometimes must be redirected to other deals at this point in his/her life.

What happens when a dental implant patient gets older?

Oral hygiene levels

Experience comes with aging. Nonetheless, more medical prescriptions, mobility problems, and sometimes social distancing.

Also, emotional and general health problems will be triggered by bone, blood, and muscle deficiencies, and those will reflect in the oral cavity (e.g., less saliva, reduced cheek volumes, reduced facial proportions).

In fact, one of the aspects that deserves a lot of attention is the ability to clean well the implant dentures at home: most patients seen at follow-up time intervals reveal manual impartments or a lack of dexterity in doing so.

At this point in life, with smoking habits, obesity and diabetes hanging on as risk factors, the perfect storm is set.  

To help a little, most of the prosthetic implant jaw replacements are attached by tiny mechanical screws only managed at the dental office.

Of course, an alternative scenario is to provide a total removable denture (an overdenture with 2-3 implants placed), but most patients feel more comfortable with the first, screwed alternative.

Another option is to “redesign” the prostheses to get more cleaning room under its gingival (intaglio) aspect, but the truth is that air space or black triangles issues are easier to manage in the lower than in the upper jaw.

Anyway, when the local inflammation is not properly controlled, a disease called peri-implantitis can be seen. Here, bone destruction will lead to dental implant losses very quickly, sometimes all of them (the so-called clustering failure phenomenon).

Bite problems, new foods, esthetics

The law of physics, especially biomechanics, shows us that lateral forces are harmful for dental implants and prostheses. Also, the number/position of occlusal contacts changes a lot in the long run.

In the elderly with conventional dentures, the ingestion of soft and sugar foods is frequent. But when a dental professional delivers an implant-supported prosthesis, a sudden shift occurs in the next months; meat and other hard foods (e.g., carrots, nuts) are reintroduced, the patient gains weight.

Not surprisingly, the bulk of the prosthesis needs to be remade according to the new lip support.

However, as the bone-implant interface has no elasticity and innervation like a natural tooth, chewing can be like a “flying blind” for the brain, as so for the newer occlusal contacts.

A great moment to rethink the near future of Brazilian implant dentistry

After a long run (more than 30 years) in the field of contemporary Implant Dentistry, amidst several national and international companies, lot of patients, implant designs, and prosthetic treatment options, dental professionals feel that a new way of thinking is mandatory.

In this way, the scientific program of the IN26 Congress highlights topics not only on Implant Dentistry, but also in Periodontics, Prosthodontics, Digital Technology, and Interdisciplinary views.

The aim is to join undergraduate and postgraduate dental students, as well as experienced dental clinicians to summarize most of the concepts and thoughts on analogic/digital global oral rehabilitation focused on preventive, treatment, and follow-up strategies.

Click here to access the full agenda of the IN Congress 26, to be held in September 22-25, at the Distrito Anhembi, Sao Paulo, Brazil.