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
PubMed ID Author / Year Patient Group Study type (level of evidence) 18807573 Tawil/2008 45 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 results This 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. 19407159 Oates/2009 32 patients and 42 implants Prospective Cohort Study Key results This 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%. 17432781 Balashi/2007 18 immediately loaded Branemark System dental implants in a 71 y/o well-insulin controlled diabetic Case report Key results In 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	(General Dentistry) (Periodontics) (Prosthodontics)
Keywords	Dental Implant, hyperglycemia, osteointegration, immediate loading
ID#	3046
Date of submission	03/13/2016
E-mail	atoyebi@livemail.uthscsa.edu
Author	Esther Atoyebi
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Thomas Oates, DMD, PhD
Faculty mentor e-mail	oates@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available