Page 20 - GP fall 2023

The Effect of the Level of Glycemic Control on Dental Implant
Survival in Patients with Type 2 Diabetes

Authors: Liana Umbrio, Gary Berkowitz, DDS, and Analia Veitz-Keenan, DDS, FAGD
Background intake, which can lead to challenges in gly- function seemed predictably high in pa-
Type-2 diabetes mellitus is characterized cemic control and complications in the pre- tients with an HbA1c below 8%, ranging
by insulin resistance with relative insulin vention of diabetes. For this reason, many from 92.6% to 100%. Studies that includ-
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deficiency. It is usually associated with people with diabetes look towards dental ed patients with poorer glycemic control
abnormal insulin secretion in multiple or- prosthetics. Diabetes mellitus is a relative showed reduced survival with higher gly-
gans: skeletal muscle, liver, adipose tissue, risk factor for dental implant therapy as cemic index. This article had an excellent
and the heart. After eating, increased blood it can negatively affect osseointegration, methodology because it had strict inclu-
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glucose levels induce insulin production which is a prerequisite for a successful den- sion criteria and only selected studies with
and secretion by pancreatic islet β cells tal implant. Microvascular complications documented glycemic control based on
into the blood. The binding of insulin and can affect osseointegration during the six- HbA1C levels. 10
insulin receptors in cell membranes causes month healing period. Therefore implant
glucose uptake by the cells, resulting in de- survival past 6-12 months is ideal because The second article, Does a higher glycemic
creased glucose levels in the blood. Failure patients with poorly controlled diabetes level lead to a higher rate of dental im-
of the pancreas to produce sufficient insulin seem to have delayed osseointegration fol- plant failure?: A meta-analysis, measured
or improper insulin action results in hyper- lowing implantation. Despite their differ- implant failure based on glycemic con-
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glycemia. Hyperglycemia and insulin defi- ences, the literature often uses dental im- trol. Studies using both HbA1C and FPG
ciency cause the host’s immune response plant survival and success interchangeably. were used. Total implant failure rates were
to be disrupted, in addition to the risk of Implant survival is defined as whether the 3.15% for patients with well-controlled di-
natural barrier damage due to neuropathy. implant physically remains in the mouth abetes and 5.32% for patients with diabetes
Diabetes-related mechanisms that impair after follow-up or has been removed. Den- that were not well-controlled. The pooled
the host’s defense against pathogens in- tal implant success measures peri-implant analysis results did not indicate a direct as-
clude suppression of cytokine production, clinical health variables, like pain, probing sociation between the glycemic level in pa-
defects in phagocytosis, dysfunction of pocket depth, marginal bone loss, and im- tients with diabetes and the dental implant
immune cells, and failure to kill microbes. plant survival. Implant failure is the term failure rate. There was no significant differ-

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Patients with poor control may present with for an implant that was lost or required ence between implant failures in patients
hyperglycemia and metabolic acidosis. Pa- removal. The literature review aims to as- with well-controlled diabetes versus pa-
tients with poorer glycemic control have an sess the evidence concerning the impact of tients with diabetes that were not well-con-
increased risk of infections, delayed wound glycemic control in patients requiring tooth trolled (P = .354). 11
healing, and micro- and macrovascular replacement by dental implants.
complications. Uncontrolled diabetics are The third article, A critical review of Dia-
at greater risk of retinopathy, neuropathy, Methodology betes, glycemic control, and dental implant
nephropathy, and cardiovascular or cere- The search strategy for this review in- therapy, tested implant failure rate based on
brovascular disease like stroke and heart volved using PubMed and Epistemonikos the level of glycemic control. Most of the
attack. databases. The goal of the search was to de- studies included did not report how the gly-
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termine if the level of glycemic control in cemic control was documented or used in-
There are three standard methods to mea- diabetic patients affects dental implant sur- adequate methods such as FPG and 2-hour
sure glycemic control: percent of glycated vival. The search included keywords such PPG, which do not give long-term glyce-
A1c hemoglobin (HbA1C), fasting plasma as “diabetes, control, dental implants” and mic control. Three studies with acceptable
glucose (FPG), and post-prandial glucose “glycemic control, dental implants” within glycemic control measurements had im-
(PPG). The HbA1C value, based on the a timeline of the past ten years. The results plant failure rates ranging from 0-9.1%.
average circulating time of red blood cells were manually filtered by title and abstract Only one of the three studies even experi-
(RBCs), which is 60–90 days, is the pre- for relevance to the topic. Three systematic enced implant failures. This study followed
ferred method as it reflects a longer term of reviews were selected. The systematic re- patients for 1 to 12 years and had a cumula-
average blood glucose levels. An HbA1C views were critically appraised to evaluate tive implant failure rate of 2.9% for all dia-
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value of 6.5% equates to a diabetes diag- each article’s intervention and control, the betic patients and 3.9% for non-controlled
nosis. An HbA1C value greater than 8% outcome, key results, and limitations. diabetic patients.
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is commonly regarded as poor glycemic
control due to the increased risk of adverse Results Conclusions
clinical manifestations. The prevalence Three systematic reviews were selected to No statistically significant evidence shows
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and severity of periodontal disease are as- answer the clinical question. that implant failure rates are significant-
sociated with increasing levels of HbA1c ly higher in patients with poor glycemic
and microvascular complications rather The first article, Does Glycemic Control control than in those with good glycemic
than the mere diagnosis of diabetes melli- Have A Dose-Response Relationship With control. More research is needed on long-
tus. Implant Outcomes? A Comprehensive term effects, and it is essential to include
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Systematic Review And Meta-Analysis a consistent measurement of glycemic
Unfortunately, patients with diabetes have analyzes implant survival and success ac- control when searching for or developing
an increased frequency of tooth loss, which cording to clinical parameters. In summary, studies. Studies suggest that there are sim-
affects masticatory function and nutrient implant survival in the first three years of ilar implant survival rates in patients with

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