The important think is to prevent secondary infections and bleeding disorders in these patients. Antibiotic prophylaxis is highly recommended before this procedures in this high risk group of patients

Too me the question is a little too vague To provide a specific answer. What do we consider as an "old patient" and what is the extent of the"cardiovascular disease"?

Chronologic age is not a consistent risk factor with dental implant treatment. Likewise the presence of cardiovascular disease, in and of itself, does not increase the risk of dental implant surgery. If you are asking about anesthesia risks you should probably use the ASA risk categories. In most instances for dental implant surgery ASA categories I and II represent low risk. The higher the category number the greater the anesthesia risk. A simple search of the Internet using "ASA Risk" Will show you the risk categories.

I agree with Emeritus Prof Steven Eckert.

Factors affecting the success or failure rate to consider are:

1. Chronological age in the context of 'biological' age -frailty (ability to maintain dental hygiene procedures post-implant) together with other co-morbidities-( nutritional, respiratory, diabetes, local disease affecting vascularity of maxilla and mandible)

2. Cardiovascular disease- diagnosis, stable and treated or otherwise, use of anticoagulants in management of cardiac disease.

3. Cardiovascular disease in the context of anaesthetic risk (ASA)- as pointed out by Emeritus Prof Steven Eckert

The details of these considerations would affect the success or failure rate.

I completely agree both with Dr Eckert and Dr D'Netto, but would like to add information about the study of Wu et. al. (1), who reported a higher survival rate of implants in patients treated with anti-hypertensive therapy. Thus, not only the disease itself, but also the therapy need to be considered as it might influence bone metabolism directly, or via an indirect pathway.

However, in patients with cardiovascular disease, managing surgical risks is imperative (2).

(1) Wu, X., Al-Abedalla, K., Eimar, H., Arekunnath Madathil, S., Abi-Nader, S., Daniel, N. G., Nicolau, B. & Tamimi, F. (2016) Antihypertensive Medications and the Survival Rate of Osseointegrated Dental Implants: A Cohort Study. Clinical Implant Dentistry & Related Research 18: 1171-1182.

(2) Schimmel, M., Müller, F., Suter, V. & Buser, D. (2017) Implants for Elderly Patients. PERIODONTOLOGY 2000 73: 228-240.

Number of years ago I was treating an endocrinologist who was a very philosophic individual. I learned much About disease and patient management from my provision of prosthodontic care for this patient.

one of the things that he said that I often think about is that no medications come to the clinical market initially when tested in combination with other medications that the patients may be taking. Whew, That's an awkward sentence!

What he was saying was that a new drug that goes through the process of entering the marketplace always has some level of scrutiny applied to the drug. The pharmaceutical manufacturers ensure that drugs are tested with good control of all other variables. The reason for this is that the pharmaceutical company wants to make sure that they are isolating any positive or negative effects from the influence that other medications could have on that new medication.

Let's take a real common example. When warfarin was first introduced to the market many many many years ago if the patients in the initial clinical study were periodically taking amoxicillin for a specific infection for which amoxicillin is indicated the amoxicillin would interfere with the action of the warfarin and alter the INR (if they were using INR that many years ago) thereby demonstrating less predictability through the use of this medication.

I'm sure you get the point. The reality is that elderly patients are often taking multiple medications for multiple reasons and although we may be able to look up each of those medications are ability to look at the accumulated effect of polypharmacia are often difficult to predict. So even when we look at things that are as simple as the ASA classification we have to realize that there are a large number of unknown factors that we may well face.

It is difficult task to give a clear information about this problem nowadays

Patients with cardiovascular disease and or cardiovascular risk factor submitted to dental implant surgery require monitoring by multidisciplinary team.

During osseointegration some factors that increase implant failure rate include health problems that affect the bone healing process such as uncontrolled diabetes (cardiovascular risk factor).

After osseointegration, clinical and radiographic follow up of these patients with implants should include evaluations of pain, mobility, bone crest loss, probing depth and peri-implantitis. Also, genetic factors such as polymorphisms in interleukin-1 genes can be used to monitor the status of the implant site and minimize the chances of failure.

Agree with RB Araujko re diabetes, as mentioned in my previous answer.