today EAO Stockholm 2015, 25 September

implant news2 EAO Annual Scientific Congress 2015 · 25/26 September DuringaFridaymorningsession at EAO 2015 in Stockholm, Prof. Martin Schimmel from the Divi- sion of Gerodontology at the Uni- versity of Bern will be discussing some of the ethical and financial challengesrelatedtoimplanttreat- ment of the elderly. today spoke with him about these issues and theimportanceofofferingthisvul- nerable population the benefits of implant therapy. today international: Implant manufacturers seem to be ex- clusively targeting younger age groups nowadays. Do you think the silver generation is being overlookedwhenitcomestoim- plant therapy and, if so, what could be the reasons for this? Prof. Martin Schimmel: I do not think that statement is true. Tooth loss is increasingly associ- ated with elderly people. In my opinion, most manufacturers of dental implants are aware of the fact that people in the Western worldareretainingtheirownteeth for longer owing to the successful implementation of preventive measures. The treatment of trauma cases inyoungerpeopleisratherlimited. At the same time, the clientele for implant treatment is becoming in- creasingly older. Data from the Department of Oral Surgery and Stomatology at the University of Bern’s dental clinic clearly demon- strates this. Narrow-diameter im- plants are also explicitly marketed as “Gero” implants nowadays. Why do older patients benefit from implant therapy in partic- ular? Particularlyfullyedentulouspa- tients and those with an edentu- lous mandible benefit the most. Stabilising mandibular complete dentureswiththehelpofendosteal implants is one of the greatest achievements in dentistry. Scien- tific studies have found many posi- tive effects, including improved quality of life, satisfaction with dentures, masticatory functional- ity and reduced bone atrophy. Partially edentulous patients can benefit from fixed implant prostheses functionally, as well as structurally. Conventional remov- abledentureshaveproventobein- ferior, especially in free-end situa- tions. Duringapaneldiscussionatthe EAO congress last year in Rome, it was found unanimously that there is no age limit for implant therapy. What is the maximum age at which dental implants could reasonably be used? Ageperseisnotacontra-indica- tion. Even in palliative care, im- plants may still play a valid role. Excluding people from the bene- fits of this therapy owing to their statistically lower remaining lifes- pan is unethical. However, one must consider exactly the point at which implants in the mouth do more harm than good—primum non nocere (above all, do no harm)—particularly in situations where cleaning is no longer possi- ble and implants become merely a surface to which biofilms adhere. Furthermore, the possibility of medicalcontra-indicationsdoesin- crease with old age. What factors play a crucial role in the implant treatment of eld- erly patients, and what factors do clinicians need to consider compared with treatment of other age groups? Of course, the interindividual variability between patients in- creases with age, meaning that the older the patient, the more person- alised treatment strategies have to be. The planning and implementa- tionneedtobeconstantlyadjusted to medical, psychological and so- cial individualities. Minimally in- vasive surgical approaches and prosthetic treatment methods that take the reduced adaptability and other physiological changes due to age into account have proven suc- cessful in this respect. In Western countries, the gap between rich and poor is ever widening.Elderlypeoplearein- creasingly falling into the latter group. What measures can help to ensure their access to dental implant treatment? The only path to broad access to these therapies for financially less well-off patients lies in private or public insurance systems. These are political issues. However, den- tists, dental technicians and the in- dustry are constantly working on industrial production structures andtherebyreducingcosts.Digital developments in dentistry will surely help to provide patients with otherwise expensive treat- ments for a much more reasonable price. Nevertheless, oversimpli- fied production methods are often not suitable for the complex treat- ment needs of the elderly. You have pointed out the bene- fits of digital production meth- ods.Whatothermeasurescould also facilitate access to dental implants for the elderly? Nowadays, the bulk of the costs incurredisduetothehoursofwork performed by the dental team and technicians. Digital processes can help to shorten treatment times through innovative workflows. Moreover,quasi-industrialproduc- tion methods can be used in less- complexcases,thusreducingcosts further. It is important to note that im- plant manufacturers have main- tained or even lowered their price levels for quite some time. How- ever,itremainsimportanttoevalu- ate the economic value of using low-cost implants, because they can have a much higher failure rate, as demonstrated by a recent Swedish study (Derks et al. 2015). From a health policy stand- point, do you see any deficits in the subsidisation of dental im- plants for the elderly? This might differ from country to country. In Switzerland, for ex- ample, the subsidisation of pa- tientswithlowincomeisevaluated individually by local authorities. The treatment of persons who re- ceive social security benefits or needs-based minimum benefits is subsidised if implant therapy can be performed in a simple, econom- ical and appropriate way. Two in- ter-foraminal implants, for exam- ple, will be reimbursed if conven- tional prosthetic treatment is not able to restore a patient’s chewing ability. In the statutory health insur- ance system, there is an obligation toperformthetherapyifthelossof teeth was due to the occurrence or treatment of a severe disease, or to anaccidentorbirthdefect.Thereis certainly room for other indica- tions, but one also has to consider the burden for the social security systems. In my opinion, Switzer- land has established a sufficient and balanced system. Thank you very much for the interview. The DTI publishing group is composed of the world’s leading dental trade publishers that reach more than 650,000 dentists in more than 90 countries. PRINT DIGITAL EDUCATION EVENTS AD “Age per se is not a contra-indication” An interview with EAO presenter and University of Bern professor Dr Martin Schimmel,Switzerland Prof. Dr Martin Schimmel

today EAO Stockholm 2015, 25 September

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