ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dental Implants in the Diabetic Patient
Clinical Question In adults with diabetes, does dental implant treatment result is significantly greater implant failure than in healthy patients?
Clinical Bottom Line No unequivocal tendency for subjects with well controlled diabetes to have significantly higher implant failure rates have emerged. (See Comments on the CAT below)
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) 16968386Mombelli/2006Total of 2823 diabetic and non diabetic patients who had received dental implant treatment in 15 different studies.Systematic Review
Key resultsNo tendency for subjects with diabetes to have higher failure rates emerged. The percentage of failing dental implants for well controlled diabetic patients appeared to lie within the normal range.
#2) 12950846Quirynen/2003Total of 620 implants placed in 163 diabetic patients in 3 separate studies.Systematic Review
Key resultsThe slightly elevated risk of implant failure experienced by diabetic patients correlates with a lack of glycemic control exercised by the diabetic patient.
Evidence Search National Library of Medicine (PubMed) was searched using the following terms in a mesh search format: Diabetes Mellitis, Dental Implants, Dental Restoration Failure ...view in PubMed
Comments on
The Evidence
The best available evidence is from a review of 15 studies conducted by Mombelli et. al., in 2006. These included eight case series of diabetic patients treated with implants, six cross-sectional, longitudinal or retrospective evaluations and one matched control retrospective chart survey (Mombelli et. al.). However, the heterogeneity of the material and the method of data reporting precluded a formal meta-analysis. No unequivocal tendency for subjects with diabetes to have higher failure rates emerged. In the eight case series that were reviewed: (1) more failures in diabetic patients occurred early, and (2) the percentage of diabetic patients experiencing failures were higher than in the control group, but the percentage of failing implants appeared to lie within the normal range. The study by Quirynen et. al., reports similar findings pointing out that the degree of metabolic control exercised by the diabetic patient influences the slightly elevated risk of implant failure experienced by diabetic patients.
Applicability These findings would be relevant to diabetic patients considering dental implant treatment. The findings would encourage patients to either maintain a high level of glycemic control in those patients who have displayed stable glycemic indexes, or possibly to encourage non- stable diabetic patients to begin to show a track record of glycemic control as a correlation to successful dental implant treatment.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Basic Science)
Keywords Periodontics, Diabetes Mellitis, Dental Implants, Dental Restoration Failure
ID# 264
Date of submission: 11/11/2009spacer
E-mail pedalino@livemail.uthscsa.edu
Author Peter M. Pedalino, DDS, MS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Brian L. Mealey, DDS, MS
Faculty mentor/Co-author e-mail MEALEY@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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Sarah Chilmeran (San Antonio, TX) on 04/03/2012
I conducted a PubMed search on this topic in April 2012 and found a more recent publication: PubMed ID 19905942. This systemic review of 18 studies further strengthens the conclusion of this CAT.
by Brian Mealey (San Antonio, TX) on 03/30/2011
It is important to note that there are few clinical trials specifically examining implant failure rates in diabetic patients with various levels of glycemic control. This is an important “missing piece” of the evidence base since we cannot say whether or not poorly controlled diabetic patients have implant failure rates similar to, higher than, or lower than failure rates in diabetic patients with good glycemic control.
by C. Denise Beitel, RDH, MS (San Antonio, TX) on 01/27/2010
I have heard and read anecdotal comments to the contrary of dental implants in diabetics. This is encouraging to operator and diabetic patient.
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