Dental implants in the elderly population: a systematic review and meta-analysis

Objective: This systematic review was conducted to evaluate the outcome of dental implant therapy in elderly patients (>= 65 years). Material and Methods: Online database and hand searches were systematically performed to identify studies reporting on dental implants placed in the partially/completely edentulous jaws of elderly patients. Only prospective studies reporting on regular-diameter (>= 3 mm), micro-rough surface implants were included in this review. Two investigators performed the search and data extraction. An inter-investigator reliability was verified using kappa statistics (kappa). A meta-analysis was performed on implant survival rates, while the mean peri-implant marginal bone level changes (PI-MBL), technical/mechanical complications, and biological complications were reported descriptively. Results: The systematic search yielded 2221 publications, of which 11 studies were included for statistical analyses. The calculated j for the various parameters extracted was kappa = 0.818-1.000. A meta-analysis was performed on the post-loading implant survival rates at 1, 3, 5, and 10 years. The random-effects model revealed an overall 1-year implant survival of 97.7% (95% CI: 95.8, 98.8; I-2 = 0.00%, P = 0.968; n = 11 studies). The model further revealed an overall implant survival of 96.3% (95% CI: 92.8, 98.1; I 2 = 0.00%, P = 0.618; n = 6 studies), 96.2% (95% CI: 93.0, 97.9; I-2 = 0.00%, P = 0.850; n = 7 studies), and 91.2% (95% CI: 83.4, 95.6; I-2 = 0.00%, P = 0.381; n = 3 studies) for 3, 5, and 10 years, respectively. The reported 1-year average PI-MBL ranged between 0.1 and 0.3 mm, while the reported 5-and 10-year PI-MBL were 0.7 and 1.5 mm, respectively. Information obtained pertaining to the technical and biological complications in the included studies was inadequate for statistical analysis. The frequent technical/mechanical complications reported were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, and fractures. The common biological complication reported included peri-implant mucositis, mucosal enlargement, bone loss, pain, and implant loss. Conclusions: This review provides robust evidence favoring dental implant therapy in elderly patients as a predictable long-term treatment option, in terms of implant survival, clinically acceptable PI-MBL changes, and minimal complications. Therefore, age alone should not be a limiting factor for dental implant therapy.