Background The authors conducted a prospective cohort study to determine whether poor glycemic control is a contraindication to implant therapy in patients with type 2 diabetes. Methods The study sample consisted of 117 edentulous patients, each of whom received two mandibular implants, for a total of 234 implants. Implant-retained mandibular overdentures were loaded after a four-month healing period and followed up for an additional one year. The authors assessed implant survival and stability (by means of resonance frequency analysis) relative to glycated hemoglobin A1c (HbA1c) levels, with baseline levels up to 11.1 percent and levels as high as 13.3 percent over one year. Results Implant survival rates for 110 of 117 patients who were followed up for one year after loading were 99.0 percent, 98.9 percent and 100 percent, respectively, for patients who did not have diabetes (n = 47), those with well-controlled diabetes (n = 44) and those with poorly controlled diabetes (n = 19). The authors considered the seven patients lost to follow-up as having had failed implants; consequently, their conservative estimates of survival rates in the three groups were 93.0 percent, 92.6 percent and 95.0 percent (P = .6510) . Two implants failed at four weeks, one in the nondiabetes group and the other in the well-con trolled diabetes group. Delays in implant stabilization were related directly to poor glycemic control. Conclusions The results of this study indicate that elevated HbA1c levels in patients with type 2 diabetes were not associated with altered implant survival one year after loading. However, alterations in early bone healing and implant stability were associated with hyperglycemia. Practical Implications Within the clinical parameters of this study, the findings indicate likely implant success among patients with type 2 diabetes who lacked good glycemic control. Further investigation, including longer-term evaluation, is needed.

Focused Clinical Question: How should the extraction socket be managed after tooth removal? Summary: Resorptive changes that take place after tooth extraction can result in a significant reduction in alveolar ridge width and height. This may create a problem for proper implant placement and fabrication of esthetic restorations. Ridge preservation has been shown to be effective in decreasing alveolar bone resorption after tooth removal. During ridge preservation, the extraction socket is filled with graft material, and a barrier is generally used to contain the graft. Flap reflection is usually not recommended if the socket walls are intact and the ridge width is sufficient after tooth removal. However, if significant breakdown of the buccal bony plate is present, mucoperiosteal flap elevation may be required to allow proper placement of the bone graft and membrane. Different types of bone grafts (autograft, allograft, and xenograft) and barrier membranes (resorbable and non‐resorbable) have been evaluated in clinical studies. They all are shown to be effective regardless of the material or technique used. Conclusions: Ridge preservation is an effective procedure for minimizing horizontal and vertical alveolar ridge resorption after tooth extraction. Current evidence does not support one technique as being superior to another. The selection of the technique to be used should be based on the clinical situation.