Diabetes and Oral Implant Failure

Abstract

The aim of this systematic review and meta-analysis was to investigate whether there are any effects of diabetes mellitus on implant failure rates, postoperative infections, and marginal bone loss. An electronic search without time or language restrictions was undertaken in March 2014. The present review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included clinical human studies. The search strategy resulted in 14 publications. The I 2 statistic was used to express the percentage of total variation across studies due to heterogeneity. The inverse variance method was used for the random effects model when heterogeneity was detected or for the fixed effects model when heterogeneity was not detected. The estimates of an intervention for dichotomous outcomes were expressed in risk ratio and in mean difference in millimeters for continuous outcomes, both with a 95% confidence interval. There was a statistically significant difference (p = .001; mean difference = 0.20, 95% confidence interval = 0.08, 0.31) between diabetic and non-diabetic patients concerning marginal bone loss, favoring non-diabetic patients. A meta-analysis was not possible for postoperative infections. The difference between the patients (diabetic vs. non-diabetic) did not significantly affect implant failure rates (p = .65), with a risk ratio of 1.07 (95% confidence interval = 0.80, 1.44). Studies are lacking that include both patient types, with larger sample sizes, and that report the outcome data separately for each group. The results of the present metaanalysis should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.

Dental implants in diabetic patients: retrospective cohort study reporting on implant survival and risk indicators for excessive marginal bone loss at 5 years

“…4 This report was nevertheless limited by the quality of the studies included, considered by the authors to be at high risk of bias and confounding factors. 4,16 A prospective study with a follow-up between 1 and 12 years with 255 implants inserted in diabetic patients registered a cumulative survival rate of 97.2% which was not significantly influenced by age, gender, diabetes duration, smoking or type of hypoglycemic therapy at the bivariate level. 8 Despite the significant number of studies reporting the outcome of dental implants in diabetic patients, there is a shortage of studies comparing the treatment outcome between type 1 and type 2 Diabetes, a result that this study was not able to infer due to the limited number of type 1 diabetic patients and that should be further investigated.…”

“…The rehabilitation of diabetic patients was previously contraindicated given the early and excessive loss of teeth caused by periodontitis, together with an increased risk of implant failure or infection. 2 The increased risk for diabetic patients was attributed to microvascular complications that could negatively influence the post-surgical healing process, 3 rendering higher dental implant failure rates 3 and increased marginal bone resorption 4 when compared to healthy patients. The status of glycemic control was previously considered an important parameter, with a compromised implant stability reported in type 2 diabetic patients with uncontrolled glycaemia.…”

How do peri‐implant biologic parameters correspond with implant survival and peri‐implantitis? A critical review

“…An increased susceptibility for periodontitis may translate into an increased susceptibility for implant loss, loss of supporting bone, and/or postoperative infection (Chrcanovic, Albrektsson & Wennerberg, 2014). No significant relation could be identified between diabetes and implant failure as no differences were observed between patients with and without diabetes (Chrcanovic, Albrektsson & Wennerberg, 2014). As concluded in multiple articles, the difference in occlusal loading between immediate non‐functional and immediate functional loading may not affect the survival of these implants and no significant effect on the marginal bone loss has been reported (Chrcanovic, Albrektsson & Wennerberg, 2014).…”

Dental implant survival rate in well-controlled diabetic patients. A systematic review.

“…Oates et al 29 and Chrcanovic et al 30 . However, these reviews did not take into account inclusion and exclusion criteria as rigorous as the ones used in this review, so that their analysis may have confounding factors and bias.…”