Implant therapy in older patients: Prosthetic considerations and biomechanical implications for frailty/aging

Population aging is reshaping prosthodontic care for both partially and completely edentulous individuals. In older adults, conditions such as frailty, comorbidities, polypharmacy, and cognitive decline can have a direct impact on the biological and biomechanical demands of implant therapy, thereby influencing the success of implant treatment.

This narrative review synthesizes evidence on implant therapy in older patients, integrating prosthetic and biomechanical considerations with patient-related factors. The literature search addressed implant survival, complications, prosthetic and material design, peri-implant soft tissue considerations, and treatment options such as shortened dental arch approaches, implant-assisted removable partial dentures (IARPDs), implant overdentures, and complete dentures, as well as maintenance strategies with patient and caregiver education.

Implant survival in older patients remains high, and age alone should not be considered as a limiting factor for implant treatment. Hygiene-oriented prosthetic designs, including non-mucosa-contact intaglio surfaces and emergence angles less than 30°, were associated with reduced plaque accumulation and peri-implant bone loss in older adults. While limited keratinized mucosa correlated with greater plaque and recession, phenotype modification should be evaluated on a case-by-case basis, carefully weighing the benefits against the surgical burden for the older patient. Ceramic materials accumulate less plaque as compared with processed acrylic resin, and veneered zirconia remained more prone to chipping than monolithic zirconia. Alternative treatment options-such as overdentures to enhance bite force, a shortened dental arch when posterior implants are contraindicated, or IARPDs to improve stability-may be especially appropriate for older patients with functional limitations. Caregiver participation and structured maintenance significantly reduce peri-implantitis risk.

Implant therapy in older patients, including individuals aged 75 years and above, is highly feasible when age-related risks are addressed, prostheses are designed for cleansability and retrievability, and maintenance includes structured follow-up and caregiver support.

Clinicians should emphasize functional goals, hygiene-accessible designs, pragmatic treatment alternatives, selective peri-implant soft tissue management when indicated, and personalized maintenance supported by patient and caregiver education.