Dental Tribune Asia Pacific Edition

Dental TribuneAsia Pacific Edition | 11/201506 WORLD NEWS State of health and risk factors differ distinctly among individuals, espe- cially the elderly. In an interview with DentalTribune,Prof.Martin Schimmel, HeadoftheDivisionofGerodontology at the University of Bern,spoke about ethical and financial challenges re- garding implant treatment of the eld- erlyandtheimportanceofofferingthis vulnerable population the benefits of implanttherapy. Dental Tribune: Implant manufactur- ers seem to be exclusively targeting youngeragegroupsnowadays.Doyou think the silver generation is being overlooked when it comes to implant therapy and, if so, what could be the reasonsforthis? Prof. Martin Schimmel: I do not think that statement is true. Tooth loss is increasingly associated with elderly people. In my opinion, most manufacturers of dental implants are aware of the fact that people in theWesternworldareretainingtheir own teeth for longer owing to the successful implementation of pre- ventivemeasures. The treatment of trauma cases in younger people is rather limited. At the same time, the clientele for implant treatment is becoming in- creasingly older. Data from the De- partment of Oral Surgery and Stom- atology at the University of Bern’s dental clinic clearly demonstrates this. Narrow-diameter implants are alsoexplicitlymarketedas“Gero”im- plantsnowadays. Why do older patients benefit from implanttherapyinparticular? Particularly fully edentulous pa- tients and those with an edentulous mandible benefit the most. Stabilis- ing mandibular complete dentures with the help of endosteal implants is one of the greatest achievements in dentistry. Scientific studies have found many positive effects, includ- ing improved quality of life, satis- faction with dentures, masticatory functionality and reduced bone atrophy. Partially edentulous patients can benefit from fixed implant prosthe- sesfunctionally,aswellasstructurally. Conventional removable dentures have proven to be inferior, especially infree-endsituations. During a panel discussion at the EAO congresslastyearinRome,itwasfound unanimously that thereisnoagelimit for implant therapy.What is the max- imum age at which dental implants couldreasonablybeused? Ageperseisnotacontra-indication. Even in palliative care, implants may stillplayavalidrole.Excludingpeople from the benefits of this therapy ow- ingtotheirstatisticallylowerremain- ing lifespan is unethical. However, one must consider exactly the point at which implants in the mouth do moreharmthangood—primumnon nocere [above all, do no harm]—par- ticularly in situations where cleaning is no longer possible and implants become merely a surface to which biofilmsadhere.Furthermore,thepos- sibility of medical contra-indications doesincreasewitholdage. What factors play a crucial role in the implant treatment of elderly patients, and what factors do clinicians need to consider compared with treatment of otheragegroups? Of course, the interindividual va- riability between patients increases with age, meaning that the older the patient, the more personalised treatment strategies have to be. The planning and implementation need tobeconstantlyadjustedtomedical, psychological and social individu- alities. Minimally invasive surgical approaches and prosthetic treat- mentmethodsthattakethereduced adaptability and other physiological changesduetoageintoaccounthave provensuccessfulinthisrespect. InWesterncountries,thegapbetween richandpooriseverwidening.Elderly peopleareincreasinglyfallingintothe lattergroup.What measurescanhelp to ensure their access to dental im- planttreatment? 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, dentists, dental technicians and the industry are constantly working on industrial production structures and thereby reducing costs. Digital develop- mentsindentistrywillsurelyhelpto provide patients with otherwise ex- pensivetreatmentsforamuchmore reasonableprice.Nevertheless,over- simplified production methods are often not suitable for the complex treatmentneedsoftheelderly. You have pointed out the benefits of digital production methods. What other measures could also facilitate access to dental implants for the elderly? Nowadays, the bulk of the costs incurred is due to the hours of work performed by the dental team and technicians. Digital processes can help to shorten treatment times throughinnovativeworkflows.More- over, quasi-industrial production methodscanbeusedinless-complex cases, thus reducing costs further. It is important to note that implant manufacturers have maintained or even lowered their price levels for quitesometime.However,itremains important to evaluate the economic valueofusinglow-costimplants,be- cause they can have a much higher failure rate, as demonstrated by a recent Swedish study (Editorial note: Derksetal.2015). From a health policy standpoint, do you see any deficits in the subsidisa- tionofdentalimplantsfortheelderly? This might differ from country to country.InSwitzerland,forexample, the subsidisation of patients with lowincomeisevaluatedindividually bylocalauthorities.Thetreatmentof persons who receive social security benefits or needs-based minimum benefitsissubsidisedifimplantther- apy can be performed in a simple, economical and appropriate way. Twointer-foraminalimplants,forex- ample,willbereimbursedifconven- tionalprosthetictreatmentisnotable torestoreapatient’schewingability. In the statutory health insurance system, there is an obligation to per- form the therapy if the loss of teeth was due to the occurrence or treat- mentofaseveredisease,ortoanacci- dentorbirthdefect.Thereiscertainly room for other indications, but one also has to consider the burden for the social security systems. In my opinion,Switzerlandhasestablished asufficientandbalancedsystem. Thankyouverymuchfortheinterview. “Age per se is not a contra-indication” An interview with University of Bern professor Dr Martin Schimmel, Switzerland By Daniel Zimmermann,DTI AD Dr Martin Schimmel DTAP1115_06_Schimmel 20.11.15 14:33 Seite 1 DTAP1115_06_Schimmel 20.11.1514:33 Seite 1

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