To what extent should dental implant placement be adopted as a standard for diabetic patients?

Relationship Between Diabetes Mellitus and Periodontal/Peri-Implant Disease: A Contemporaneous Review

The prevalence of diabetes mellitus (DM), a major chronic disease and a leading cause of death and disability around the world, is rising. According to the latest data, the global prevalence of DM has increased to 463 million (9.3% of adults) in 2019 and is estimated to reach 700 million by 2045. Periodontal disease, result of periodontium inflammation, is a common, chronic disease and has long been considered one of the complications of DM. Moreover, literature reflects a spectrum of conflicting viewpoints on the effect of diabetic conditions on the implant treatment strategies. The current review aims to update the recent epidemiologic evidence regarding the relationship between DM and periodontal/peri-implant disease, emphasising the effects of glycaemic control on the severity of these diseases and describing the pathobiological mechanisms underlying this association. This review's findings indicate a bidirectional relationship between DM and periodontal/peri-implant disease and that this relationship seems causal, implying that controlling these two diseases might help prevent each other's incidence. Additionally, the severity of periodontal/peri-implant disease is directly related to metabolic control. Although patients with diabetes can obtain implant success similar to those in systemically healthy individuals, an increased risk of peri-implantitis has been reported in DM patients. Therefore, the importance of glycaemic control and maintaining proper oral hygiene cannot be overstated.

Diabetes Mellitus and Its Influence on Oral Health: Review

Diabetes mellitus (DM) is one of the most common diseases all over the world. The effect of this endocrine disease on body systems cannot be ignored, where its oral side effects are well distinguished. As this disease incident is increasing dramatically, it is essential for the health care providers to be fully aware of the disease diagnosis, management and to deal with it in a full confident. This review discusses the disease itself, its complications, methods of diagnosis as well as its management. Furthermore, oral manifestations and dental considerations that should be followed when treating patients with diabetes mellitus have been discussed in this review.

The association between medical diseases and orofacial abscess: A retrospective, hospital-based study

OBJECTIVE

This study aimed to identify the most commonly reported medical diseases among dental patients and to assess its association with the development of the orofacial abscess.

METHODS

The medical records (n = 3164) of dental patients who visited the dental hospital at Umm-Al-Qura University (Makkah, Saudi Arabia) were reviewed. Demographic characteristics of eligible patients were collected. Medical diseases were collected as reported by the patients in the medical records. The International Classification of Diseases (ICD-10) was used to classify the reported medical diseases. Simple descriptive statistics were used to define the characteristics of the study variables through a form of counts and percentages. Multivariable logistic regression analysis was carried out to find out the significant predictors of orofacial abscess.

RESULTS

Upon reviewing 3164 medical records, almost half of the patients had medical diseases (n = 1543, 49%). The mean age of the cohort was 30.3 (SD = 16.43). Diabetes mellitus (n = 316, 20%) and hypertension (n = 210, 14%) were the most common reported medical diseases. Male patients reported having more medical diseases compared to the female. Hypertension was found to be significantly high among female patients (X 2 = 3.167, P-value < 0.001). Multivariable logistic regression analysis indicated that the female gender is significantly associated with the development of orofacial abscess after adjustment for age and vascular risk factors (i.e., hypertension) (B = 1.26, S.E. = 0.57, OR = 3.54, 95%CI = 1.13 to 11.40, P-value = 0.028).

CONCLUSION

Dentists should be aware that diabetes mellitus and hypertension are prevalent among patients visiting dental services. The female gender has a higher association of developing orofacial abscess than male. Within the limitation of this study in a single study center with few patients having orofacial abscess, this study found no association between medical diseases and the development of orofacial abscess.

Dental Implants with a Calcium Ions-Modified Surface and Platelet Concentrates for the Rehabilitation of Medically Compromised Patients: A Retrospective Study with 5-Year Follow-Up

Background: Platelet concentrates are biological, autologous products obtained from the patient’s whole blood, consisting of a supraphysiological concentration of platelets and growth factors, that have proved beneficial in different applications in the medical and dental fields. They are used in several medical and dental applications to enhance tissue healing. Previous evidence shows that platelet concentrates may be beneficial in patients with compromised systemic conditions, in which the healing process is impaired. Aim: To evaluate the 5-year clinical outcome of implant treatment using acid-etched implants with calcium ions-modified surface in association with plasma rich in growth factors, in patients with systemic diseases of a different nature. Methods: Charts of 99 medically compromised patients, who had received a total of 224 dental implants from January 2013 to June 2013, were retrospectively evaluated. Patients were divided into four groups, according to their condition: diabetes (n = 39 patients), osteoporosis (n = 36), lupus erythematosus systemic (n = 5), rheumatoid arthritis (n = 19). The main outcomes were implant survival, marginal bone level (MBL) change and complications throughout follow-up. Results: Mean follow-up was 63.06 ± 1.90 months (range 60.1 to 66.4 months). In total, eight implants failed in 6 diabetic patients and 4 in 3 patients with rheumatoid arthritis. Overall 5-year implant survival was 94.6%. In total, 30 complications occurred in 24 patients, mostly transient, and no severe adverse event occurred. Overall MBL change was 0.45 ± 0.12 mm, with no significant differences among groups. Conclusions: In the present sample of medically compromised patients, rehabilitation with calcium ions-modified surface implants associated with plasma rich in growth factors proved to be a safe and effective treatment. The satisfactory results achieved after 5-year follow-up are comparable to those historically reported for healthy patients.

Assessment of failure rate of dental implants in medically compromised patients

Background and Aims:

The present study was conducted to assess failure rate of dental implant in medically compromised patients.

Methods:

This study comprised of 68 medically compromised patients of both genders who underwent dental implants 5 years ago (Group I). Equal number of healthy subjects was taken as control (Group II). Amount of bone loss around the implant over 1mm of bone loss in the first year and over 0.3 mm bone loss every subsequent year were considered as failures.

Results:

The age group of 30-40 comprised of 25 patients in group I and 35 in group II, 40-50 years had 27 in group I and 23 in group II and 50-60 years had 16 in group I and 10 in group II. Medically compromised patients were diabetes (25) with 30 dental implants followed by osteoporosis (16) with 17 dental implants, hypothyroidism (12) with 14 dental implants, organ transplant (10) with 12 dental implants and CVD (5) with 7 dental implants. Chi- square test was applied which revealed significant difference in patients (P < 0.05). In group I, there were 18 (22.5%) and in group II, there were 4 (5.56%) dental implant failures. The difference with chi- square test found to be significant P < 0.05).

Conclusion:

Among medically compromised conditions, higher failure rate was found in diabetes.

Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews

Background

Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme.

Material and Methods

An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed.

Results

We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome.

Conclusions

Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies.

Key words:Dental implants, diabetes, systematic review, meta-analysis, survival rate.