Title	Controlled Diabetic Patients Undergoing Implant Therapy Have Similar Survival Rates Compared to Healthy Individuals
Clinical Question	Do diabetic patients desiring implant therapy, compared to non-diabetic patients, have lower implant survival rates?
Clinical Bottom Line	Implant therapy can be carried out in healthy and diabetic patients with an expectation of similar survival and success rates. This finding is supported by a systematic review that demonstrated that, in diabetic patients with good glycemic control, implant procedures are safe and predictable with a complication rate similar to that of healthy patients. Frequent recall visits should be done to detect early signs of peri-implantitis in diabetic patients.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 27747697 Naujokat/2016 9,614 diabetic and non-diabetic patients who had received dental implant treatment in 22 studies Systematic review Key results Implant survival rate for diabetic patients ranged from 100% to 96.4% at 1 year and 97.2% to 92% at 5 years in studies with a healthy control; these rates were similar to survival rates in non-diabetic patients. Poorly controlled diabetic patients have shown delayed osseointegration, although after 1 year the success of osseointegration is the same among healthy and diabetic patients. Risk of peri-implantitis is higher in diabetic patients. No difference in the success of bone augmentation procedures was found. HbA1c levels within a normal range indicates good glycemic control, and there was evidence that good glycemic control improves osseointegration and implant survival.
Evidence Search	“Diabetes Mellitus and dental implants” [MeSH]
Comments on The Evidence	The systematic review by Naujoka et al. had strict inclusion and exclusion criteria. A total of 327 articles were identified and screened, out of which 305 articles were excluded based on the title, abstract evaluation, and full-text article. The 22 articles selected were prospective, retrospective and cross-sectional studies. Despite the strict inclusion criteria, all 22 articles studied had a low level of evidence in terms of individual study design; however, all studies were rated as having only low or medium risk of bias. Also, there was a high level of heterogeneity among all articles considered in terms of methods and results. Note that the CAT #634, published in 2011, also addressed the topic of implant failure rates in diabetics and was updated in 2014 with more recent evidence.
Applicability	Dentists can deliver dental implant therapy in well-controlled diabetic patients with predictable survival rates. Good glycemic control should be established to to improve the success of osseointegration. Diabetic patients should keep their HbA1c levels within the normal range to decrease the likelihood for complications with implants.
Specialty	(Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords	Dental implants, diabetes, osseointegration, survival rates
ID#	3320
Date of submission	07/06/2018
E-mail	supneet.wadhwa@ucdenver.edu
Author	Supneet Singh Wadhwa
Co-author(s)	Bobby Keyvan-Jafari, Domonique Coleman
Co-author(s) e-mail
Faculty mentor	Ethelyn Thomason
Faculty mentor e-mail	ethelyn.thomasonlarsen@ucdenver.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