ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Local Insulin Delivery Around Titanium Implants at the Time of Placement Increases Biomechanical Retention in Rats
Clinical Question Will local insulin delivery in type 1 and type 2 diabetics improve biomechanical retention of titanium implants relative to that in type 1 and type 2 diabetics who do not receive local insulin delivery?
Clinical Bottom Line In diabetic rats, local insulin delivery around titanium implants at time of placement improved biomechanical implant retention, bone-implant contact, and bone volume relative to diabetic rats who did not receive local insulin. Human studies have yet to be conducted.
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) 22871310Han/201296 male Wistar rats, in which T1D was induced by STZ injection, divided randomly into 8 treatment groups.Animal Study
Key resultsGroup 1 consisted of healthy rats which received no treatment and Group 2 consisted of T1D rats which also received no treatment. Groups 3 and 5 consisted of T1D rats each group receiving a different method of placebo treatment. And Groups 4, 6, 7, and 8 consisted of T1D rats, each group receiving treatment via different methods of administration of local insulin delivery. All groups of T1D rats receiving local insulin delivery showed significant increases in mean removal torque (RTQ) test values compared to Group 2 (T1D control group) (p < 0.01). The mean RTQ value of the FGIPM (local insulin delivery method) treatment group was statistically comparable to that of Group 1 (healthy control group) (p < 0.05), indicating that it was the most efficacious treatment modality.
#2) 20438725Wang/201020 male SPF rats with T2D – randomly divided into 2 groupsAnimal Study
Key resultsGroup 1 consisted of T2D rats which were treated with rrIGF-1-loaded PLGA microspheres, while Group 2 consisted of T2D rats treated with placebo PLGA microspheres. Rats receiving rrIGF-1-loaded PLGA microspheres (insulin-like growth factor-1) showed greater bone-implant contact around the titanium implants (p < 0.05).
#3) 20400213Wang/201130 GK rats - divided evenly into 3 groups of 10.Animal Study
Key resultsGroup 1 consisted of healthy rats which received no treatment, Group 2 consisted of T2D rats which received local insulin delivery at time of implant placement, and Group 3 consisted of T2D rats which received no treatment. Both "bone-implant contact" and "bony volume" were evaluated in this study. Bone-implant contact and bony volume of Group 3 was significantly less than that of Group 1 (control) and Group 2 (local insulin delivery) (p < 0.05 and p < 0.01, respectively). The bone-implant contact in Group 2 was less than Group 1, but the bony volume was much greater than that of Group 1 (p < 0.05).
Evidence Search diabetic[All Fields] AND ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields] OR ("dental"[All Fields] AND "implant"[All Fields]) OR "dental implant"[All Fields]) AND local[All Fields] AND ("insulin"[MeSH Terms] OR "insulin"[All Fields])
Comments on
The Evidence
These conclusions drawn from the literature are both significant and accurate, yet come from the lowest level study design, animal testing, yielding the least valid form of evidence. Human trials must be performed to observe the effect of local insulin delivery on the biomechanical retention of titanium implants and either confirm or deny the validity of these articles. While retention was increased in the diabetic rats who did in fact receive local insulin delivery relative to those who did not, there was no mention of any side effects of the insulin. Assuming the dosage is minimal, as the treatment is only localized delivery, note should be made whether or not side effects were seen, and if they were not, a maximum effective dose should be determined.
Applicability Although these results are from animal studies, the pathophysiology of diabetes mellitus in rats applies that in humans; thus the results can apply in humans. Assuming future successful human trials, the applicability of local insulin delivery could encompass all diabetic dental patients undergoing implant placement.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Diabetes, diabetics, dental implants, retention, longevity, success
ID# 3224
Date of submission: 04/19/2017spacer
E-mail sallaway@livemail.uthscsa.edu
Author McKay Sallaway
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Archie Jones, DDS, MBA
Faculty mentor/Co-author e-mail jonesa@uthscsa.edu
Basic Science Rationale
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