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Rehabilitative Considerations for Dental Implants in the Diabetic Patient

  • Review Article
  • Published:
The Journal of Indian Prosthodontic Society

Abstract

Diabetes is a serious illness that affects many people, and there are many new cases diagnosed every year in all populations around the world. Dental implant is one of the restorative methods to replace missing teeth. As implants are directly anchored into bones, they provide stability, a more natural appearance, and minimize the risk of bone resorption. Thus, today, there is a high demand of dental implants and it is inevitable to meet diabetics who request implant treatment. However, Diabetes mellitus patients may pose contraindications to dental implants because of microvascular complications leading to slower healing process after surgery. Studies have shown that dental implantation failure rate in diabetic patients is much higher than that in non-diabetic patients. This article reviews the effect of diabetes on the osseointegration of implants and the soft tissue healing. It presents the factors used in assessing the severity of diabetes and its complications, as well as considerations for rehabilitation planning in these patients. In addition, the role of antibiotic prophylaxis has been reviewed since its effect on wound healing in diabetics is controversial. Integration of these factors by the dentist can dictate whether, as well as what type of implant supported prosthesis should be given to the diabetic patient.

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References

  1. Chalmers J, Joshi R, Patel A (2008) Advances in reducing the burden of vascular disease in type 2 diabetes. Clin Exp Pharmacol Physiol 35:434–437

    Article  PubMed  Google Scholar 

  2. Loo WTY, Jin LJ, Cheung NB, Wang M (2009) The impact of diabetes on the success of dental implants and periodontal healing. Afr J Biotechnol 8(19):5122–5127

    Google Scholar 

  3. Aronson D (2008) Hyperglycemia and the pathobiology of diabetic complications. Adv Cardiol 45:1–16

    Article  PubMed  Google Scholar 

  4. Bianchi C, Miccoli R, Penno G, Del Prato S (2008) Primary prevention of cardiovascular disease in people with dysglycemia. Diabetes Care 31(2):S208–S214

    Article  PubMed  Google Scholar 

  5. American academy of periodontology (1999) Diabetes and periodontal disease (position paper). J Periodontol 70:935–949

    Article  Google Scholar 

  6. Cianciola RJ, Park BH, Bruck E, Mosovich L, Genco RJ (1982) Prevalence of periodontal disease in insulin dependent diabetes mellitus (juvenile diabetes). J Am Dent Assoc 104:653–660

    PubMed  Google Scholar 

  7. Schlossman M, Knowler WC, Pettitt DJ, Genco RJ (1990) Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 121:532–536

    Google Scholar 

  8. Park JB (2007) Bone healing at a failed implant site in a type II diabetic patient: clinical and histologic evaluations: a case report. J Oral Implantol 33:28–32

    Article  PubMed  Google Scholar 

  9. He H, Liu R, Desta T, Leone C, Gerstenfeld LC, Graves DT (2003) Diabetes causes decreased osteoclastogenesis, reduced bone formation and enhanced apoptosis of osteoblastic cells in bacteria stimulated bone loss. Endocrinology 145:1447–1452

    Article  Google Scholar 

  10. Santana RB, Xu L, Babakhanlou C, Chase HB, Amar S et al (2003) A role for advanced glycation end products in diminished bone healing in type 1 diabetes. Diabetes 52:1502–1510

    Article  PubMed  Google Scholar 

  11. Weiss RE, Gora A, Nimni ME (1981) Abnormalities in the biosynthesis of cartilage and bone proteoglycans in experimental diabetes. Diabetes 30:670–677

    Article  PubMed  Google Scholar 

  12. Nyomba BL, Verhaegue J, Tomaste M, Nyomba BL, Verhaeghe J, Thomasset M, Lissens W, Bouillon R (1989) Bone mineral homeostasis in spontaneously diabetic BB rats. Abnormal vitamin D metabolism and impaired active intestinal calcium absorption. Endocrinology 124:565–572

    Article  PubMed  Google Scholar 

  13. Brownlee M (2001) Biochemistry and molecular cell biology of diabetic complications. Nature 414:813–820

    Article  PubMed  Google Scholar 

  14. Ceriello A (2000) Oxidative stress and glycemic regulation. Metabolism 49:27–29

    Article  PubMed  Google Scholar 

  15. Hammes HP, Martin S, Federlin K, Geisen K, Brownlee M (1991) Aminoguanidine treatment inhibits the development of experimental diabetic retinopathy. Proc Natl Acad Sci USA 88:11555–11559

    Article  PubMed  Google Scholar 

  16. Mahadev K, Wu X, Zilbering A, Lawrence JT, Goldstein BJ (2001) Insulin stimulated hydrogen peroxide generated during cellular insulin stimulation is integral to activation of the distal insulin signaling cascade in 3T3-L1 adipocytes. J Biol Chem 276:48662–48669

    Article  PubMed  Google Scholar 

  17. Marfella R, Quagliaro L, Nappo F, Ceriello A, Giugliano D (2001) Acute hyperglycemia induces an oxidative stress in healthy subjects. J Clin Invest 108:635–636

    PubMed  Google Scholar 

  18. Nishikawa T, Edelstein D, Du XL, Yamagishi S, Matsumura T, Kaneda Y et al (2000) Normalizing mitochondrial superoxide production blocks three pathways of hyperglycemic damage. Nature 404:787–790

    Article  PubMed  Google Scholar 

  19. Campus G, Salem A, Uzzau S, Baldoni E, Tonolo G (2005) Diabetes and periodontal disease: a case control study. J Periodontol 76:418–425

    Article  PubMed  Google Scholar 

  20. Ervasti T, Knuutilla M, Pohjamo L, Haukipuro K (1985) Relation between control of diabetes and gingival bleeding. J Periodontol 56:154–157

    Article  PubMed  Google Scholar 

  21. Gusberti FA, Syed SA, Bacon G, Grossman N, Loesche WJ (1983) Puberty gingivitis in insulin dependent diabetic children. J Periodontol 54:714–720

    Article  PubMed  Google Scholar 

  22. Karjalainen KM, Knuuttila MLE (1996) The onset of diabetes and poor metabolic control increases gingival in children and adolescents with insulin-dependent diabetes mellitus. J Clin Periodontol 23:1060–1067

    Article  PubMed  Google Scholar 

  23. Seppala B, Seppala M, Ainamo J (1993) A longitudinal study on insulin dependent diabetes mellitus and periodontal disease. J Clin Periodontol 20:161–165

    Article  PubMed  Google Scholar 

  24. Tervonen T, Oliver RC (1993) Long term control of diabetes mellitus and periodontitis. J Clin Periodontol 20:431–435

    Article  PubMed  Google Scholar 

  25. Sastrowijoto SH, Hillemans P, van Steenbergen TJ, Abraham-Inpijn L, De Graaff J (1989) Periodontal condition and microbiology of healthy and diseased periodontal pockets in type I diabetes mellitus patients. J Clin Periodontol 16:316–322

    Article  PubMed  Google Scholar 

  26. Zambon JJ, Reynold H, Fisher JG, Shlossman M, Dunford R, Genco RJ (1988) Microbiological and immunological studies of adult periodontitis in patients with non-insulin dependent diabetes mellitus. J Periodontol 59:23–31

    Article  PubMed  Google Scholar 

  27. Manoucher-Pour M, Spagnuolo PJ, Rodman HM, Bissada NF (1981) Comparison of neutrophil chemotactic response in diabetic patients with mild and severe periodontal disease. J Periodontol 52:410–415

    Article  Google Scholar 

  28. McMullen JA, Van Dyke TE, Horoszevicz HU, Genco RJ (1981) Neutrophil chemotaxis in individuals with advanced periodontal disease and a genetic predisposition to diabetes mellitus. J Periodontol 52:167–173

    Article  PubMed  Google Scholar 

  29. Salvi GE, Yalda B, Collins JG, Jones BH, Smith FW, Arnold RR, Offenbacher S (1997) Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin dependent diabetes mellitus. J Periodontol 68:127–135

    Article  PubMed  Google Scholar 

  30. Salvi GE, Yalda B, Collins JG, Arnold RR, Lang NP, Offenbacher S (1997) Monocytic TNF-α secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol 24:8–16

    Article  PubMed  Google Scholar 

  31. Ryan ME, Ramamurthy NS, Geolub NM (1996) Matrix metalloproteinases and their inhibition in periodontal treatment. Curr Opin Periodontol 3:85–96

    PubMed  Google Scholar 

  32. Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, Pettitt DJ (1996) Severe periodontitis and risk for glycemic control in patients with non-insulin dependent diabetes mellitus. J Periodontol 67:1085–1095

    Article  PubMed  Google Scholar 

  33. D’Aiuto F, Parker M, Andreou G, Suvan J, Brett PM, Ready D, Tonetti MS (2004) Periodontitis and systemic inflammation: control of local infection is associated with a reduction in serum inflammatory markers. J Dent Res 83:156–160

    Article  PubMed  Google Scholar 

  34. McCracken M, Lemons JE, Rahemetulla F, Prince CW, Feldman D (2000) Bone response to titanium alloy implants placed in diabetic rats. Int J Oral Maxillofac Implants 15:345–354

    PubMed  Google Scholar 

  35. Nevins ML, Karimbux NY, Weber HP, Giannobile WV, Fiorellini JP (1998) Wound healing around endosseous implants in experimental diabetes. Int J Oral Maxillofac Implants 13:620–629

    PubMed  Google Scholar 

  36. Kopman JA, Kim DM, Rahman SS, Arandia JA, Karimbux NY, Fiorellini JP (2005) Modulating the effects of diabetes on osseointegration with aminoguanidine and doxycycline. J Periodontol 76:614–620

    Article  PubMed  Google Scholar 

  37. Morris HF, Ochi S, Winkler S (2000) Implant survival in patients with type 2 diabetes: placement to 36 months. Ann Periodontol 5:157–165

    Article  PubMed  Google Scholar 

  38. Valero AM, García JC, Ballester AH (2007) Effects of diabetes on the osseointegration of dental implants. Med Oral Patol Oral Cir Bucal 12:E38–E43

    Google Scholar 

  39. Fiorellini JP, Chen PK, Nevins M, Nevins ML (2000) A retrospective study of dental implants in diabetic patients. Int J Periodontics Restorative Dent 20:366–373

    PubMed  Google Scholar 

  40. Balshi TJ, Wolfinger GJ (1999) Dental implants in the diabetic patient: a retrospective study. Implant Dent 8:355–359

    Article  PubMed  Google Scholar 

  41. Esposito M, Hirsch JM, Lekholm U, Thomsen P (1997) Failure patterns of four osseointegrated oral implant systems. J Mater Sci Mater Med 8:843–847

    Article  PubMed  Google Scholar 

  42. Olson JW, Shernoff AF, Tarlow JL, Colwell JA, Scheetz JP, Bingham SF (2000) Dental endosseous implant assessments in a type 2 diabetic population: a prospective study. Int J Oral Maxillofac Implants 15:811–818

    PubMed  Google Scholar 

  43. Farzad P, Andersson L, Nyberg J (2002) Dental implant treatment in diabetic patients. Implant Dent 11:262–267

    Article  PubMed  Google Scholar 

  44. Peled M, Ardekian L, Tagger-Green N, Gutmacher Z, Machtei EE (2003) Dental implants in patients with type 2 diabetes mellitus: a clinical study. Implant Dent 12:116–122

    Article  PubMed  Google Scholar 

  45. Ayson M, leichter J, Lyons K (2006) Dental implants: patient selection factors. An evidence based review. MSc thesis, University of Otago, School of Dentistry

  46. Alsaadi G, Quirynem M, Komarek A, Van Steenberghe D (2008) Impact of local and systemic factors on the incidence of late oral implant loss. Clin Oral Implants Res 19:670–676

    PubMed  Google Scholar 

  47. Alsaadi G, Quirynem M, Komarek A (2007) Impact of local and systemic factors on the incidence of late oral implant failures, up to abutment connection. Int J Oral Maxillofac Implants 34:610–617

    Google Scholar 

  48. Alvim-Pereira F et al (2008) Analysis of association of clinical aspects and vitamin D receptor gene polymorphism with dental implant loss. Clin Oral Implants Res 19(8):786–795

    Article  PubMed  Google Scholar 

  49. Klokkevold PR, Han TJ (2007) How do smoking, diabetes, and periodontitis affect outcomes of implant treatment? Int J Oral Maxillofac Implants 22(Suppl):173–202; erratum appears in Int J Oral Maxillofac Implants. 2008;23(1):56

    PubMed  Google Scholar 

  50. Kourtis SG et al (2004) Private practice results of dental implants. Part I: survival and evaluation of risk factors—Part II: surgical and prosthetic complications. Implant Dent 13(4):373–385

    PubMed  Google Scholar 

  51. Mundt T et al (2006) Private practice results of screw-type tapered implants: survival and evaluation of risk factors. Int J Oral Maxillofac Implants 21(4):607–614

    PubMed  Google Scholar 

  52. Harris MI, Hadden WC, Knowler WC, Bennett PH (1987) Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in the U.S. population aged 20–74 years. Diabetes 36:523–534

    Article  PubMed  Google Scholar 

  53. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26:S5–S20

    Article  Google Scholar 

  54. American Diabetes Association (2004) Screening for type 2 diabetes. Diabetes Care 27:S11–S14; S5–S20

    Article  Google Scholar 

  55. Klein MI (1995) Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 18:258–268

    Article  PubMed  Google Scholar 

  56. Michaeli E, Weinberg I, Nahlieli O (2009) Dental implants in the diabetic patient: systemic and rehabilitative considerations. Quintessence Int 40:645–649

    Google Scholar 

  57. Miley DD, Terezhalmy GT (2005) The patient with diabetes mellitus: etiology, epidemiology, principles of medical management, oral disease burden, and principles of dental management. Quintessence Int 36:779–795

    PubMed  Google Scholar 

  58. Knowler WC (1994) Screening for NIDDM: opportunities for detection, treatment and prevention. Diabetes 17:445–450

    Google Scholar 

  59. Peters AL, Davidson MB, Schriger DL, Hasselblad V (1996) A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. Meta-Analysis Research Group on the Diagnosis of Diabetes using Glycated Hemoglobin Levels. JAMA 276:1246–1252

    Article  PubMed  Google Scholar 

  60. Steinhauer T, Bsoul SA, Terezhalmy GT (2005) Risk stratification and dental management of the patient with cardiovascular diseases. Part I: etiology, epidemiology, and principles of medical management. Quintessence Int 36:119–137

    PubMed  Google Scholar 

  61. Steinhauer T, Bsoul SA, Terezhalmy GT (2005) Risk stratification and dental management of the patient with cardiovascular diseases. Part II: the oral disease burden and principles of dental management. Quintessence Int 36:209–227

    PubMed  Google Scholar 

  62. McCance DR, Hanson RL, Charles MA, Jacobsson LT, Pettitt DJ, Knowler WC, Bennet PH (1994) Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes. BMJ 308:1323–1328; Erratum in BMJ 309:841

    Google Scholar 

  63. Engelgau MM, Thompson TJ, Herman WH, Boyle JP, Aubert RE, Kenny SJ, Badran A, Sous ES, Ali MA (1997) Comparison of fasting and 2-hour glucose and HbA1c levels for diagnosing diabetes: diagnostic criteria and performance revisited. Diabetes 20:785–791

    Article  Google Scholar 

  64. Jackson CA, Yudkin JS, Forrest RD (1992) A comparison of the relationships of the glucose tolerance test and the glycated hemoglobin assay with diabetic vascular disease in the community: the Islington Diabetes Survey. Diabetes Res Clin Pract 17:111–123

    Article  PubMed  Google Scholar 

  65. Beks PJ, Mackay AJC, de Neeling JND, De Vries H, Bouter LM, Heine RJ (1995) Peripheral arterial disease in relation to glycaemic level in elderly Caucasian population: the Hoorn Study. Diabetologia 38:86–96

    Article  PubMed  Google Scholar 

  66. Lockhart PB, Schmidtke MA (1994) Antibiotic considerations in medically compromised patients. Dent Clin North Am 38:381–402

    PubMed  Google Scholar 

  67. Hall EH, Sherman RG, Emmons III, Naylor GD (1994) Antibacterial prophylaxis. Dent Clin North Am 38:707–718

    PubMed  Google Scholar 

  68. Heydman JC, Nelson CL (1986) Short term preventive antibiotics. Clin Orthop Relat Res 205:184

    Google Scholar 

  69. Conver MA, Kaban LB, Mulliken JB (1985) Antibiotic prophylaxis for major maxillocraniofacial surgery. J Oral Maxillofac Surg 43:865

    Article  Google Scholar 

  70. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE (2002) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Amn Coll Cardiol 39:542–553

    Article  Google Scholar 

  71. Kim RB (ed) (2003) The medical letter handbook of adverse drug interactions. The Medical Letter Inc., New Rochelle, p 142

    Google Scholar 

  72. Kim RB (ed) (2003) The medical letter handbook of adverse drug interactions. The Medical Letter Inc., New Rochelle, p 143

    Google Scholar 

  73. Moy PK, Medina D, Shetty V, Aghaloo TL (2005) Dental implant failure and associated risk factors. Int J Oral Maxillofac Implants 20:569–577

    PubMed  Google Scholar 

  74. Albrektsson T, Brånemark P-I, Hansson H-A, Lindström J (1981) Osseointegrated titanium implants. Requirements for ensuring a longlasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 52:155–170

    Article  PubMed  Google Scholar 

  75. Johnson BW (1992) HA-coated dental implants: long-term consequences. J Calif Dent Assoc 20:33–41

    PubMed  Google Scholar 

  76. Salak R (1985) Aspect of biomechanical considerations. In: Brånemark PI, Zarb GA, Albrektsson T (eds) Tissue-integrated prostheses. Osseointegration in clinical dentistry. Quintessence Publishing Company, Chicago; Chapter 5

    Google Scholar 

  77. Marchand F, Raskin A, Dionnes-Hornes A, Barry T, Dubois N, Valéro R, Vialettes B (2012) Dental implants and diabetes: conditions for success. Diabetes Metab 38(1):14–19

    Article  PubMed  Google Scholar 

  78. Palmer R, Palmer P, Floyd P (1999) Dental implants: basic implant surgery. Br Dent J 187:415–421

    PubMed  Google Scholar 

  79. Ericsson RA (1984) Heat-induced bone tissue injury. Thesis, Department of anatomy, University of Gothenburg, Sweden

  80. Ericsson RA, Adell R (1986) Temperatures during drilling for the placement of implants using the osseointegration technique. J Oral Maxillofac Surg 44:4–7

    Article  Google Scholar 

  81. Röstlund T, Carlsson L, Albrektsson B, Albrektsson T (1989) Osseointegrated knee prostheses. An experimental study in rabbits. Scand J Plast Reconstr Surg Hand Surg 23:43–46

    Article  PubMed  Google Scholar 

  82. Balshi SF, Wolfinger GJ, Balshi TJ (2007) An examination of immediately loaded dental implant stability in the diabetic patient using resonance frequency analysis (RFA). Quintessence Int 38(4):271–279

    PubMed  Google Scholar 

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Correspondence to Preeti Agarwal Katyayan or Manish Katyayan.

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On 14th November 2010 as faculty paper and won best paper award.

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Katyayan, P.A., Katyayan, M. & Shah, R.J. Rehabilitative Considerations for Dental Implants in the Diabetic Patient. J Indian Prosthodont Soc 13, 175–183 (2013). https://doi.org/10.1007/s13191-012-0207-9

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