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Diabetes mellitus and dental implants

31 March 2022

Diabetes mellitus is a metabolic disease that develops primarily either due to T-cell-mediated autoimmune destruction, especially of the beta cells of the islets of Langerhans in the pancreas (type I diabetes mellitus) or due to impaired insulin function (various combinations of insulin resistance, hyperinsulinism, relative insulin deficiency, or even secretory disorders; type II diabetes mellitus). In particular, the micro- and macroangiopathy that develops in the context of diabetes mellitus, as well as excessive plaque accumulation, have already been correlated in affected patients with a higher prevalence of periodontal disease, tooth loss, impaired wound healing, impaired bone remodeling, and impaired response to infection compared to the normal population. While diabetes mellitus was often seen as a relative contraindication for the placement of dental implants in the past, several studies have subsequently shown that patients suffering from it can also benefit from oral implant restorations. However, the evidence here was not always homogeneous, particularly in patients with poorly adjusted glycemic profiles, so the aim of this current brief analysis of the recent literature was to subsume and analyze the more recent studies in this setting.
While in 2000 the global prevalence of patients with diabetes mellitus of all ages was estimated at just under 3%, current analyses calculate an increase of adult diabetics up to 4.4% in 2030. Consequently, the estimation of complications during and after the placement of dental implants in diabetics is of high relevance. In animal studies, but also in the context of clinical investigations, a worsened wound healing could be observed in the presence of diabetes mellitus. Nevertheless, pure implant survival seems to be similar in diabetics compared to systemically healthy patients. However, studies on patients with poorly or even very poorly controlled blood glucose and long-term studies are lacking. Clinical evidence further shows that the presence of (poorly controlled) diabetes mellitus may well be associated with peri-implant soft tissue inflammation and crestal bone loss. Thus, chronic hyperglycemia is considered an important risk factor for peri-implant disease. Here, due to the impairment of bone metabolism, peri-implantitis in particular has become the focus of investigation. Thus, an altered host response in combination with hyperglycemia-induced excessive accumulation of bacterial plaque probably contributes to a more pronounced progression of peri-implant disease compared to metabolically healthy patients. In particular, patients with poorly controlled diabetes mellitus (in most studies with an HbA1c > 8%) have been shown to have abnormal expression of interleukin-8, MMP-8, vitamin D, osteocalcin, and TNF-alpha. Analogous to these results, many of the current literature analyses – although not homogeneous – come to the conclusion that diabetes mellitus and in particular poor glycemic control correlate significantly with the predisposition and development of peri-implantitis. However, with regard to the studies of lower evidence level included here, oral hygiene in particular, including local plaque control, seems to play a relevant role, which may be more important than the presence of systemic diseases. However, further studies are needed for evidence-based decision making.
Author(s)	Source
Kämmerer PW, Lehmann KM	Deutscher Ärzteverlag, ZZI, 2021,37, 03 (german)
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