Is implant therapy indicated for diabetic patients? A systematic review

This summary is based on the article published in Clinical Oral Implants Research: A critical review of diabetes, glycemic control, and dental implant therapy (February 2013)

Context

Diabetes mellitus has long been considered a relative contraindication to dental implant therapy and is increasingly becoming one of the most commonly encountered contraindications to dental implant therapy. (1)

Our understanding of diabetes mellitus as a relative contraindication based on the patient’s level of glycemic control has changed little since the 1988 NIH Consensus Conference on Dental Implants and  well-controlled diabetic patients may be considered appropriate for implant therapy while diabetic patients lacking good glycemic control may be denied the benefits of implant therapy.

Purpose of the Review

To critically assess the evidence available for the use of implant therapy for patients with diabetes based on glycemic control. Clinical studies directly examining the relationship between diabetes and implant survival, and the potential for glycemic control to serve as an appropriate discriminator for the application of care, are evaluated. The use of implant therapy in special populations requires consideration of potential benefits to be gained from the therapy.

Key Messages

Clinical evidence is lacking for the association of glycemic control with implant failure while support is emerging for implant therapy in diabetes patients with appropriate accommodations for delays in implant integration based on glycemic control.

The role for implants to improve oral function in diabetes management and the effects of hyperglycemia on implant integration remain to be determined.

Glycemic control is a primary consideration for patients with diabetes. There is a clear correlation between glycemic control and the development of microvascular and macrovascular complications. (2)

Masticatory function and diabetes. Periodontal disease frequently results in tooth loss, with the cumulative effects most significant in older patients (Albandar et al. 1999).  (3) Diabetes has been shown to significantly increase the levels of periodontal disease and tooth loss. (4-8) Thus, one of the more subtle complications of diabetes may be a decrease in a patient’s health and quality of life due to tooth loss and compromised function. (9)

Recent study has shown that complete denture wearers benefit greatly when even as few as two implants are used to retain their mandibular dentures, reporting significantly higher satisfaction and better oral health-related quality of life. (10-15)

It is the aging population in which both tooth loss and type 2 diabetes mellitus coexist that the need may be greatest and for
whom implant therapy may offer the greatest benefit.  However, many of the benefits of implant therapy in patients with diabetes remain to be determined.

Bone metabolism and diabetes mellitus. Dental implant survival is initially dependent upon successful osseointegration following placement. Subsequently, as an implant is restored and placed into function, bone remodeling becomes a critical aspect of implant survival in responding to the functional demands placed on the implant restoration and supporting bone. The critical dependence on bone metabolism for implant survival may be heightened in patients with diabetes.

References

1. Oikarinen, K., Raustia, A.M. & Hartikainen, M. (1995) General and local contraindications for endosseal implants–an epidemiological panoramic radiograph study in 65-year-old subjects. Community Dentistry and Oral Epidemiology 23: 114–118.
2. Cohen, A. & Horton, E.S. (2007) Progress in the treatment of type 2 diabetes: new pharmacologic approaches to improve glycemic control. Current Medical Research and Opinion 23: 905–917.
3. Albandar, J.M., Brunelle, J.A. & Kingman, A. (1999) Destructive periodontal disease in adults 30 years of age and older in the united states, 1988-1994. Journal of Periodontology 70: 13–29.
4. Emrich, L.J., Shlossman, M. & Genco, R.J. (1991) Periodontal disease in non-insulin-dependent diabetes mellitus. Journal of Periodontology 62: 123–131.
5. Safkan-Seppala, B. & Ainamo, J. (1992) Periodontal conditions in insulin-dependent diabetes mellitus. Journal of Clinical Periodontology 19: 24–29.
6. Oliver, R.C. & Tervonen, T. (1993) Periodontitis and tooth loss: comparing diabetics with the general population. Journal of the American Dental Association 124: 71–76.
7. Collin, H.L., Uusitupa, M., Niskanen, L., Kontturi- Narhi, V., Markkanen, H., Koivisto, A.M. & Meurman, J.H. (1998) Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. Journal of Periodontology 69: 962–966.
8. Oliver, R.C., Brown, L.J. & Loe, H. (1998) Periodontal diseases in the united states population. Journal of Periodontology 69: 269–278.
9. McGrath, C. & Bedi, R. (2001) Can dentures improve the quality of life of those who have experienced considerable tooth loss? Journal of Dentistry 29: 243–246.
10. Boerrigter, E.M., Stegenga, B., Raghoebar, G.M. & Boering, G. (1995) Patient satisfaction and chewing ability with implant-retained mandibular overdentures: a comparison with new complete dentures with or without preprosthetic surgery. Journal of Oral and Maxillofacial Surgery 53: 1167–1173.
11. Awad, M.A. & Feine, J.S. (1998) Measuring patient satisfaction with mandibular prostheses. Community Dentistry and Oral Epidemiology 26: 400–405.
12. Awad, M.A., Lund, J.P., Shapiro, S.H., Locker, D., Klemetti, E., Chehade, A., Savard, A. & Feine, J.S. (2003) Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: a randomized clinical trial in a senior population. International Journal of Prosthodontics 16: 390–396.
13. Heydecke, G., Locker, D., Awad, M.A., Lund, J.P. & Feine, J.S. (2003) Oral and general health-related quality of life with conventional and implant dentures. Community Dentistry and Oral Epidemiology 31: 161–168.
14. Thomason, J.M., Lund, J.P., Chehade, A. & Feine, J. S. (2003) Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery. International Journal of Prosthodontics 16: 467–473.
15. Meijer, H.J., Batenburg, R.H., Raghoebar, G.M. & Vissink, A. (2004) Mandibular overdentures supported by two branemark, imz or iti implants: a 5-year prospective study. Journal of Clinical Periodontology 31: 522–526.

Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.