ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Do Endosseous Implants Have Success in Patients With Type II Diabetes Mellitus?
Clinical Question In a patient with type II diabetes mellitus, do endosseous implants have a lower success rate compared to a healthy individual?
Clinical Bottom Line Dental implants placed in patients with type II diabetes mellitus had results ranging from slightly higher failure rates to no significant difference compared to healthy patients. (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) 16958701Kotsovilis/2006Diabetic patients as well as animalsSystematic Review
Key resultsWithin the limits of the existing investigations, experimental studies seem to reveal an impaired bone healing response to implant placement in diabetic animals compared with non-diabetic controls, both quantitatively and qualitatively. The majority of clinical studies tend to indicate that diabetes is no contraindication for implant placement, on condition that it remains under metabolic control. However, definitive guidelines with objective criteria, such as type and duration of diabetes and glucosylated hemoglobin levels, need to be established in the future.
#2) 11885176Morris/20002,632 (91%) implants were placed in non-diabetic patients and 255 (8.8%) in Type 2 patientsRetrospective Analysis
Key resultsType 2 diabetic patients tend to have more failures than non-diabetic patients; however, the influence was marginally significant.
#3) 11151579Olson/200089 male type 2 diabetic subjectsClinical Trial
Key resultsThere was no statistically significant difference in failure rates between the 3 different implant systems used in this study.
Evidence Search Search "Dental Implants"[Mesh] AND "Diabetes Mellitus"[Mesh] Limits: Meta-Analysis Search "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh] Limits: ReviewSearch "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh] Limits: Meta-Analysis Search "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh]Search "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh] Limits: Randomized Controlled Trial, Search "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh] Limits: Review, Search "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh] Limits: Meta-Analysis, Search "Diabetes Mellitus"[Mesh] AND "Dental Implantation, Endosseous"[Mesh]Search ((Garrett[Author]) AND diabetes[MeSH Terms]) AND endosseous implants[MeSH Terms], Search ((Garrett[Author]) AND diabetes[MeSH Terms]) AND implants[MeSH Terms]
Comments on
The Evidence
There were comprehensive detailed searches done on the relevant trials. The Kotsovilis et al., (2006) study is a systemic review of RCTs. The Morris article appears to be a retrospective analysis of an existing database that included diabetic and non-diabetic subjects. The Olson article did not have a non-diabetic controls.
Applicability The information generated by this CAT is applicable for Type II Diabetes Mellitus individuals considering dental implants.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords
ID# 634
Date of submission: 05/05/2010spacer
E-mail koelker@uthscsa.edu
Author Kris Koelker
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author 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?)
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 Thomas Oates (San Antonio, TX) on 01/13/2014
This comment highlights the limited understanding of this relationship in 2010. There have been multiple publications that have greatly extended our understanding since this time. These findings question the role of hyperglycemia in the survival of dental implants. Please see: -for a thorough review PMID: 22111901 -recent primary study PMID: 22145978
by Ray Caesar; Kasia Szozda (San Antonio, TX) on 01/06/2014
The articles referenced in this CAT include: a animal study, a statistically inconclusive study, and a study that indicated patients with type 2 diabetes were more likely to experience dental implant failure. However, since the date of this publication, a review article by Courtney, 2010; 20521447 elucidates the effect of “glycosylated hemoglobin levels (HbA1C)” on rising success of dental implants on patients with Type 2 diabetes. In conjunction with other articles written since the publication of this CAT, evidence has been provided supporting the claim that appropriate therapy significantly improves the likelihood of a successful dental implant.
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