Should Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on: Peri-Implant Diseases

Abstract

Background and Aim: Traditionally patients with metabolic conditions such as diabetes mellitus are considered not suitable candidates for dental implant therapy due to increased risk of infection, impaired bone healing or the potential for vascular complications. Periimplantitis as the more progressive form of peri-implant disease involves bone loss and estimated to occur in nearly half of all implant cases long-term. Despite extensive research on association of hyperglycemia with dental implants in preclinical and animal models, translational effort to clinical practice is hampered by discrepancies in reported outcome indicators for peri-implantitis in patients with a spectrum of glycemic profiles. This review aims to evaluate clinical evidence for peri-implant disease in metabolically compromised patients and in particular in patients with poorly-controlled diabetes in order to inform clinical management of peri-implant disease. Materials and Methods: A comprehensive literature review was performed utilizing PubMed database and using the key word 'diabetes' combined with "dental implant" or "Periimplantitis" or/and "Preimplant disease". Results: Clinical studies with follow up more than 1year, systematic review and metaanalysis that evaluated peri-implant disease in diabetic patients in relation to glycemic control were taken into consideration in this review. Conclusion:Studies reported conflicting results regarding the long-term effect of diabetes on peri-implant health regardless of the level glycemic control. Therefore, interpretation of finding and relevance to clinical practise should be considered on individual bases.

Sustained Release of Salicylic Acid for Halting Peri-Implantitis Progression in Healthy and Hyperglycemic Systemic Conditions: A Gottingen Minipig Model

“…This may be accounted for by the peri-implant crevicular fluid of patients with peri-implantitis exhibiting increased inflammation with higher levels of interleukin (IL) 1, IL-8, and tumor necrosis factor (TNF) α, as well as matrix metalloproteinase collagenase 8 relative to the crevicular fluid of healthy patients. 88,89 Increased expression of IL-8 and TNF-α has also been observed in the peri-implant crevicular fluid of individuals with poor glycemic control compared with wellcontrolled glucose levels and healthy individuals. 55,88 Current methods applied for the treatment of periimplantitis have focused on implant surface decontamination (with approximately 0.23 mm reduction in the probing depth after treatment 71 ), local and systemic administration of antibiotics (∼0.27−0.30 mm reduction in the probing depth 70,71 ), as well as regenerative procedures using different types of bone grafts and membranes (∼0.51 mm reduction in the probing depth).…”

“…88,89 Increased expression of IL-8 and TNF-α has also been observed in the peri-implant crevicular fluid of individuals with poor glycemic control compared with wellcontrolled glucose levels and healthy individuals. 55,88 Current methods applied for the treatment of periimplantitis have focused on implant surface decontamination (with approximately 0.23 mm reduction in the probing depth after treatment 71 ), local and systemic administration of antibiotics (∼0.27−0.30 mm reduction in the probing depth 70,71 ), as well as regenerative procedures using different types of bone grafts and membranes (∼0.51 mm reduction in the probing depth). 48,49,71 The results obtained have indicated minimal bone attachment gain and probing depth reduction, 45,48 especially in individuals with pro-inflammatory Figure 7.…”

“…From a temporal perspective, the progression of the disease was faster in MS and T2DM subjects in both the mandible and the maxilla relative to normoglycemic healthy subjects. This may be accounted for by the peri-implant crevicular fluid of patients with peri-implantitis exhibiting increased inflammation with higher levels of interleukin (IL) 1, IL-8, and tumor necrosis factor (TNF) α, as well as matrix metalloproteinase collagenase 8 relative to the crevicular fluid of healthy patients. , Increased expression of IL-8 and TNF-α has also been observed in the peri-implant crevicular fluid of individuals with poor glycemic control compared with well-controlled glucose levels and healthy individuals. , …”

On Peri-Implant Bone Loss Theories: Trying To Piece Together the Jigsaw

“…The evidence as to whether diabetes is a risk factor for PI was considered “inconclusive” in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions [ 18 ]. Nevertheless, studies reporting results regardless of the level of glycemic control should be carefully interpreted [ 83 ]. Poor glycemic status (PGS) may negatively modulate bone factors (OPG, transforming growth factor beta (TGF-β), osteopontin, osteocalcin) during healing and seems to be an important factor affecting implant complication rates, including MBL [ 84 ].…”

The Influence of Low-Level Laser Therapy on CBCT Radiographic and Biochemical Profiles of Type II Controlled Diabetic Patients After Dental Implant Insertion: A Randomized Case-Control Study

“…Multiple studies had evaluated the success and failure rates of dental implants in diabetic patients, and the results were conflicting; therefore, further investigations are needed [11][12][13]. Several studies have demonstrated that low-level laser treatment (LLLT) could enhance the initial stability of osseointegrated implants in animal models [14][15][16].…”