Dental implants in patients with diabetes

Diabetics are known to frequently suffer from micro- and macroangiopathies. In addition, diabetes may be associated with increased wound healing disorders and compromised bone healing. Diabetes mellitus is therefore considered a relative risk factor for dental rehabilitation with implants, although dental implant surgery has emerged as a convenient oral rehabilitation tool in recent years. Against this background, the German Society of Implantology (DGI) and the German Society of Dental, Oral and Maxillofacial Medicine (DGZMK) have developed a current S3 guideline according to the guidelines of the Association of the Scientific Medical Societies (AWMF).

Peri-implant infections after implant placement are particularly relevant in the presence of diabetes. Although the direct influence of diabetes mellitus on the development of peri-implant infections is not clear due to heterogeneous data, the risk of peri-implant infections seems to increase over time. The guideline recommends that patients with diabetes should be informed about the possibility of developing a peri-implant infection before starting therapy.

The guideline provides recommendations for perioperative management in diabetics. For example, a disinfecting mouth rinse should be used perioperatively. In addition, the preoperative, prophylactic administration of a single antibiotic is recommended.

There is no evidence in the literature that augmentation procedures have a higher complication and failure rate in patients with well-controlled diabetes mellitus compared to patients without diabetes mellitus.

Patients with poorly controlled diabetes mellitus appear to have delayed osseointegration after implant placement; therefore, the indication for immediate and early loading should be particularly critical in these patients. The data on osseointegration in patients with well-controlled diabetes mellitus are very heterogeneous. However, after one year there seems to be no difference in implant stability between diabetics and healthy subjects.

Overall, there are no significant differences in survival rates in the first years in patients with diabetes mellitus compared to the healthy comparison group. However, in the long-term course, the risk of implant loss still seems to be increased. Accordingly, a risk-oriented follow-up after implant placement should be performed. This also includes that the treating physician or dentist is informed about the patient’s HbA1c value and, if necessary, obtains further medical clarification.

Author(s) Source
editorial zm online 07/2023 (german original)

german guideline 12-2022

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