ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Poorly Controlled Diabetes Mellitus Compromises Bone Response to Orthodontic Forces in Comparison to Well-controlled Diabetic and Monodiabetic Patients
Clinical Question Do diabetic patients have compromised bone response to orthodontic treatment in comparison to well-controlled diabetic patients and nondiabetic patients?
Clinical Bottom Line Predictable orthodontic treatment may be achieved in patients with well-controlled diabetes.
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) 21435542Villarino/2011Twenty-four male Wistar rats weighing 100-130 g. were divided into 3 groups: experimental orthodontics; experimental diabetes and orthodontics; and experimental diabetes treated with insulin and experimental orthodontics Animal Study
Key resultsHistologic sections of dental alveolus after orthodontic treatment shows a statistically significant (p<0.05) decrease of bone formation (areas covered by osteoblasts), number of osteoclasts and total erosive surfaces in diabetic animals compared to control and insulin-treated diabetic subjects at the time of histology. Bone response of insulin-treated diabetic subjects was no different than control subjects. Overall, bone formation in response to orthodontic stimulus of untreated diabetic subjects was lower than that observed in healthy or insulin-treated diabetic Wistar rats.
#2) 21244505 Braga/2011Sixty, 10-wk-old male C57BL6/J mice. Of the 60, 35 were rendered type I diabetic.Animal Study
Key resultsHistopathological slides revealed diabetic mice had statistically signficant (p < 0.05) increase in TRAP-positive cells (correlates to number of osteoclasts) and increased bone resorption relative to the normoglycemic control subjects. Diabetic mice showed greater amount of tooth movement compared with normoglycemic mice (control). Insulin-treated diabetic mice showed normalization of osteoclast numbers and of tooth movement comparable to control values.
Evidence Search ("diabetes mellitus"[MeSH Terms] OR ("diabetes"[All Fields] AND "mellitus"[All Fields]) OR "diabetes mellitus"[All Fields] OR "diabetes"[All Fields] OR "diabetes insipidus"[MeSH Terms] OR ("diabetes"[All Fields] AND "insipidus"[All Fields]) OR "diabetes insipidus"[All Fields]) AND ("orthodontics"[MeSH Terms] OR "orthodontics"[All Fields])
Comments on
The Evidence
Validity: In both Villarino and Braga’s studies, there were statistically significant differences between the diabetic and non diabetic control groups. Both studies had small sample sizes with type I diabetic models; type 2 diabetes was not discussed. More literature is needed to strengthen evidence of the conclusion. In Villarino's study, differences were noted between the groups the outcome variables were larger or smaller between the groups at the time of histology. No differences were measured within groups to establish baseline. Perspective: It is important to consider that both studies are animal studies. More literature is needed to strengthen evidence of results towards human subjects.
Applicability Orthodontic treatment may not be a contraindication for well-controlled patients with diabetes mellitus. These studies demonstrate that orthodontic forces on uncontrolled diabetic patients can have adverse effects on bone response. Orthodontists should anticipate particular concerns regarding treatment with diabetic patients. The safety and timing of orthodontic treatment with uncontrolled diabetic patients cannot be answered with current literature.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Orthodontics, diabetes mellitus
ID# 3091
Date of submission: 05/30/2016spacer
E-mail horani@livemail.uthscsa.edu
Author Suzzane Horani
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail gakunga@uthscsa.edu
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