ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Implants And Type II Diabetes
Clinical Question In patients receiving dental implants, does type II diabetes have a significant impact on the implant survival rate at 5 years as compared with that of healthy patients?
Clinical Bottom Line Patients with type II diabetes have been successfully treated with dental implants at a high survival rate; however, there is not enough evidence to definitively represent the direct comparison between healthy patients and type II diabetics receiving dental implants. (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) 12861878Peled/200341 patients with type 2 diabetes mellitusProspective non-controlled clinical trial
Key resultsFive year survival rates range from 93%-97%. The clinical outcome of dental implants in a selected group of patients with well-controlled type 2 diabetes mellitus is satisfying and encouraging. Further investigations and clinical trials over a longer period of time are needed to determine the long-term survival of implants in diverse groups of patients with diabetes mellitus.
#2) 11151579Olson/200089 male type 2 diabetic subjectsProspective non-controlled clinical trial
Key resultsSixteen (9%) of the 178 implants failed; Regression analysis found only duration of diabetes (P < .025) and implant length (P < .001) to be statistically significant predictors of implant failure. There was no statistically significant difference in failure rates between the 3 different implant systems used. This study supports the use of dental implants in type 2 diabetic patients.
#3) 11885176Morris/2000663 patients (2,887 implants); 2,632 (91%) implants in non-diabtetic patients and 255 (8.8%) in type 2 patientsRetrospective controlled clinical trial
Key resultsA model assuming independence showed that implants in Type 2 patients have significantly more failures (P = 0.020). However, if correlations among implants within the patient are considered, the significance level becomes marginal (P- 0.046)
Evidence Search Search dental implants diabetes Search "Dental Implants"[Mesh] AND "Diabetes Mellitus, Type 2"[Mesh] Limits: Randomized Controlled Trial,Search "Dental Implants"[Mesh] AND "Diabetes Mellitus, Type 2"[Mesh] Limits: Systematic Reviews,Search "Dental Implants"[Mesh] AND "Diabetes Mellitus, Type 2"[Mesh] Limits: Meta-Analysis, Search "Dental Implants"[Mesh] AND "Diabetes Mellitus, Type 2"[Mesh] Limits: Clinical Trial Search "Dental Implants"[Mesh] AND "Diabetes Mellitus, Type 2"[Mesh]
Comments on
The Evidence
Two prospective non-controlled clinical trials (Peled et. al., 2003, Olson et. al., 2000) that did not include a non-diabetic treatment group and one retrospective controlled clinical trial (Morris et al 2000) that reported only at 3 years following implant placement were identified. Therefore, no adequate literature was identified to specifically answer the PICO question. Further research is needed to give a definitive answer as to whether or not type 2 diabetic patients are at a higher risk for implant failure.
Applicability The results of the CAT are highly applicable in determining type II diabetic patients as possible implant treatment candidates. It is still unclear if patients with type II diabetes, controlled or not, receiving dental implants tend to have more failures than non-diabetic patients. However, the high implant survival rate in type II diabetics lead us to believe this is a suitable treatment option.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Implants, Diabetes mellitus
ID# 566
Date of submission: 03/31/2010spacer Revised: 04/18/2011
E-mail leej12@livemail.uthscsa.edu
Author Jason Lee
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huynh-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@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 Michael Tong (San Antonio, Texas) on 04/16/2012
I conducted a PubMed search on this topic April 2012 and found a more recent publication that reaches the same conclusion as the “Clinical Bottom Line” in this CAT. The 2008 PMID: 18724865. Meta-Analysis/Systematic Review states that “Evidence is lacking to indicate that implant therapy in subjects with diabetes yields long-term outcomes comparable with those of non-diabetic subjects.”
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