Implant Success in People with Type 2 Diabetes
Diabetes Mellitus with Varying Glycemic Control A pilot study
Submitted by Dr. Gedaliah M. Stern
DISCUSSION
The importance of maintaining stringent glycemic control to minimize some of the most common diabetic comorbidities is becoming increasingly appreciated.16 Despite these advances, however, a majority of patients with diabetes still are unable to maintain adequate glycemic control.17-19 Diabetes mellitus remains a relative contraindication to dental implant therapy that depends on the patient’s level of glycemic control. As a result, many patients who have poorly controlled diabetes may be denied the benefits of implant therapy.
Patients with diabetes have increased frequency of periodontitis and tooth loss, which can lead to compromises in chewing function and diet. The benefits of implant therapy may be even more relevant to patients with diabetes who are at an increased risk of experiencing tooth loss and who are critically dependent on managing their diabetes through diet. In fact, the patients who are most compromised may gain the most from implant therapy. Given the potential for patients with diabetes to benefit from implant based tooth replacement, we designed this study to enhance the understanding of both the limitations of and the possibilities for implant therapy in patients with diabetes by evaluating the impact of glycemic control on implant success and complications after placement in these patients.
Glycemic control in patients with diabetes is variable. The subjects enrolled in our study were being followed by their practicing physicians, and their physicians made no alterations in their care due to their participation in our study. This gave us a reasonably realistic view of the difficulties of managing diabetes in these subjects. We saw that almost one-half of the subjects changed HbA1c level groups over the four-month study period, with the greatest changes found in the subjects with less well-controlled diabetes. This variability reinforces the importance of understanding the impact of glycemic control on both short- and long-term aspects of implant care. Our findings also suggest that subjects with relatively low HbA1c levels may have dramatic changes in glycemic levels with the potential to affect implant success.
Though the results of our preliminary study do not support a detrimental effect
of hyperglycemia on implant success, this remains a possible explanation for the inconsistencies found in previous studies of implant success in patients with diabetes.
Background.
The authors conducted a prospective cohort study to explore the relationship between implant success and glycemic control in patients with type 2 diabetes mellitus.
Results.
The HbA1c levels of the subjects ranged from 4.5 to 13.8 percent.
All 50 implants were integrated clinically. The authors identified
three minor complications in three patients having HbA1c levels ranging
from 7.4 to 8.3 percent. None of these complications affected the clinical
management of the cases, and the authors did not identify any adverse
events.
Conclusions.
There was no evidence of diminished clinical success or
significant early healing complications associated with implant therapy
based on the glycemic control levels of subjects with type 2 diabetes
mellitus.
Clinical Implications.
These findings support the continued investigation
of the effects of glycemic control on implant therapy toward the
development of therapeutic guidelines that will optimize implant therapy
in patients with diabetes.
Dr. Dowell is in private practice, Abilene, Texas. When this article was written, he was a graduate student in biomedical sciences and periodontics, Department of Periodontics, University of Texas Health Science Center at San Antonio.
Dr. Oates is an associate professor, Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, e-mail “oates@uthscsa.edu
Dr. Robinson is in private practice, Austin, Texas. When this article was written, she was a graduate student in periodontics, Department of Periodontics, University of Texas Health Science Center at San Antonio.
DISCLOSURE:
The ITI Foundation, Basel, Switzerland, and the San Antonio Area
Foundation provided financial support for this study. Dr. Jim Simpson and the Institute Straumann AG, Waldenburg, Switzerland, provided the implants used in this study. Dr. Oates has participated in research sponsored by Institute Straumann AG and presented findings.
A pilot study by Scott Dowell, DDS, MS; Thomas W. Oates, DMD, PhD; Melanie Robinson, DDS, MS
©Copyright Jewish Diabetes Association. Updated may 2017