ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dental Implants Safe for Immediate Loading in Controlled Diabetics
Clinical Question Does dental implant restoration at the time of placement compromise implant survival in Diabetic patients relative to non-diabetic patients?
Clinical Bottom Line There is no apparent difference in survival of immediately loaded implants between diabetic and non-diabetic patients, but there may be compromises in implant integration in direct relation to glycemic status that may compromise immediate restoration.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18807573Tawil/200845 type II diabetic patients in which 58 implants were immediately loaded and 45 non- diabetic patients in which 59 implants were immediately loaded Prospective Cohort Study
Key resultsThis study shows no statistically significant differences in terms of implant survival, soft tissue complications, or postoperative infection were found between the type II diabetic and non-diabetic patients. None of the 58 implants immediately loaded failed for the diabetic patients, and only 1 of the 59 failed in the control group.
#2) 19407159Oates/200932 patients and 42 implantsProspective Cohort Study
Key resultsThis study shows the direct relationship between hyperglycemia and the alterations in implant stability consistent with impaired implant integration for persons with type 2 diabetes mellitus. Implant integration appears adversely affected for patients with HbA1c levels greater than 8.0%.
#3) 17432781Balashi/200718 immediately loaded Branemark System dental implants in a 71 y/o well-insulin controlled diabeticCase report
Key resultsIn this case report of a diabetic patient receiving 18 implants, there was 100% survival of all 18 immediately loaded implants over 2.5 years following placement.
Evidence Search Immediate Implant Loading, Osseointegtation, Glycemic Control
Comments on
The Evidence
The two clinical reports suggest immediate loading can be done for patients with diabetes as there were no implant failures, soft tissue complications, or mean peri-implant bone loss found. However, immediate loading was not the primary question in these studies and the evidence was not explicit in its measure of the glycemic control for immediate loading in diabetics, limiting their applicability. The second study identifies compromises with hyperglycemia that suggest caution with immediate loading in patients with poor glycemic control. Overall, more investigation is needed to ascertain a more confident conclusion for immediate implant loading Diabetes may not be as strong a contraindication to implant therapy as once thought. These studies suggest this may extend to includea more aggressive immediate loading protocol.
Applicability These articles are applicable to both dentist and patients with diabetes. Because of the poor wound healing associated with diabetes, many would deem immediate implant loading as a contraindication in Diabetic patients. However, patients with diabetes may benefit from implant therapy, perhaps including immediate implant loading.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Dental Implant, hyperglycemia, osteointegration, immediate loading
ID# 3046
Date of submission: 03/13/2016spacer
E-mail atoyebi@livemail.uthscsa.edu
Author Esther Atoyebi
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas W. Oates DMD, PhD
Faculty mentor/Co-author e-mail oates@uthscsa.edu
Basic Science Rationale
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