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Bencze B, Cavalcante BGN, Romandini M, Róna V, Váncsa S, Varga G, Kivovics M, Szabó B, Agócs G, Géczi Z, Hermann P, Hegyi P, Végh D. Prediabetes and poorly controlled type-2 diabetes as risk indicators for peri-implant diseases:A systematic review and meta-analysis. J Dent 2024; 146:105094. [PMID: 38788918 DOI: 10.1016/j.jdent.2024.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE The study answers the PECO question: "In adults with dental implants (P), do subjects suffering from type-2 diabetes or prediabetes (E) have worse peri-implant conditions (O) than subjects without type-2 diabetes and prediabetes (C)?". Prediabetes (5.7-6.4 % HbA1c), and the different qualities of glycemic control in type-2 diabetes; well-controlled (>8 % HbA1c), and poorly controlled (>8 % HbA1c) individuals; were classified according to the recommendations of the American Diabetes Association. DATA Predefined search keys were used with search terms including: Dental implant, diabetes mellitus, glycemic control and HbA1c. SOURCES An electronic search in the MEDLINE, Embase, and Cochrane libraries were conducted without any filters or language restrictions. Additionally, manual search of the reference lists were carried out to identify all relevant articles. STUDY SELECTION Eligibility criteria were cohort, case-control and cross-sectional studies that answerd our PECO question with at least 1 year of follow-up. From a total of 2660 records, 35 articles (1761 individuals) were included in the analysis. Meta-analytic difference in means for crestal bone loss was 1.2 mm [95 % CI=0.4; 2.1] in patients with prediabetes, 1.8 mm [CI=1.0; 2.7] in poorly controlled patients, whereas 0.4 mm [CI=-0.3; 1.1] in well-controlled individuals. Meta-regression showed that 1 % increase in HbA1c increased crestal bone loss by 0.24 mm. CONCLUSIONS Within the limitations of the study, patients with poorly controlled type-2 diabetes or prediabetes may have worse peri-implant conditions compared to patients without diabetes and well-controlled type-2 diabetes. Well-controlled type-2 diabetes is not a risk indicator for peri-implant diseases. CLINICAL SIGNIFICANCE Clinicians should measure blood HbA1c levels when planning implant-supported restorations, thus patients with undiagnosed or poorly controlled type-2 diabetes can be identified, that allows for glycemic level adjustment prior to dental implant surgery, ensuring peri-implant health. PROTOCOL REGISTRATION NUMBER: (CRD42022375263).
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Affiliation(s)
- Bulcsú Bencze
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | | | - Mario Romandini
- Department of Periodontology, University of Oslo, Oslo, Norway
| | - Virág Róna
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Márton Kivovics
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Community Dentistry, Semmelweis University, Budapest, Hungary
| | - Bence Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Zoltán Géczi
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hermann
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Medical School, Institute for Translational Medicine, University of Pécs, Hungary
| | - Dániel Végh
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
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Diehl D, Bespalov A, Yildiz MS, Friedmann A. Restoration of posterior teeth by narrow diameter implants in hyperglycemic and normoglycemic patients - 4-year results of a case-control study. Clin Oral Investig 2024; 28:392. [PMID: 38907052 PMCID: PMC11192651 DOI: 10.1007/s00784-024-05786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES To investigate the four-year clinical outcome and marginal bone loss around narrow-diameter implants in patients with uncontrolled diabetes mellitus type 2 (T2DM) and normo-glycemic individuals. MATERIALS AND METHODS In 11 T2DM patients with a concentration of glycated hemoglobin (HbA1C) > 6.5% (test group) and 15 normoglycemic patients (HbA1C < 6.0%; control group), one narrow-diameter tissue level implant, placed in the posterior maxilla or mandible, was investigated. The clinical parameters probing depth (PD), bleeding on probing (BOP), attachment loss (CAL), recession, and papilla bleeding index (PBI) were assessed manually after 24 and 48 months of function. The paired digital periapical radiographs were analyzed regarding the change in marginal bone level (MBL) from baseline to 48 months post-op. The technical complications were recorded. RESULTS In the T2DM group, 11 patients were available for follow-ups. The overall implant survival rate after 48 months was 100%. The differences in means for the clinical parameters and the MBL between the T2DM and normo-glycemic patients for the observation period were statistically non-significant. No technical complications were recorded. CONCLUSIONS The study demonstrated an encouraging clinical outcome with ND implants in patients with uncontrolled T2DM compared to non-diabetics after 48 months' post loading. CLINICAL RELEVANCE Patients with HbA1C > 6.5% may benefit from the treatment with narrow-diameter implants by avoiding complex surgical interventions with augmentation procedures. REGISTRATION NUMBER (CLINICALTRIALS.GOV): NCT04630691.
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Affiliation(s)
- Daniel Diehl
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/, Herdecke University, Alfred-Herrhausen Str. 45, 58455, Witten, Germany.
- Institute of Pharmacology and Toxicology, Center for Biomedical Education and Research (ZBAF), Faculty of Health, Witten/Herdecke University, Stockumer Straße 10, 58453, Witten, Germany.
| | - Angelina Bespalov
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/, Herdecke University, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | - Mehmet Selim Yildiz
- Department of Periodontology, Faculty of Dentistry, Altınbaş University, Zuhuratbaba, İncirli Cd. No:11-A, 34147 Bakırköy, Istanbul, Turkey
| | - Anton Friedmann
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/, Herdecke University, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
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Cao R, Chen B, Xu H, Fan Z. Clinical outcomes of titanium-zirconium alloy narrow-diameter implants for single-crown restorations: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2023; 61:403-410. [PMID: 37331853 DOI: 10.1016/j.bjoms.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 02/26/2023] [Accepted: 05/07/2023] [Indexed: 06/20/2023]
Abstract
Evidence is limited on whether titanium-zirconium alloy, narrow-diameter implants (Ti-Zr NDIs) have promising clinical outcomes when used to support single crowns. The purpose of this systematic review and meta-analysis was to evaluate clinical evidence, including survival rates, success rates, and marginal bone loss (MBL) on Ti-Zr NDIs that support single crowns. An extensive search was performed in the databases of PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library for studies published in English up to April 2022. Only peer-reviewed clinical studies with at least 10 patients and a follow-up time of at least 12 months were included. Risk of bias in each study was assessed and data extraction was carried out independently by two reviewers. The outcome variables were survival rates, success rates, and MBL. The search returned 779 results. Eight studies were identified for qualitative analysis and seven for quantitative synthesis. Overall, a total of 256 Ti-Zr NDIs were included. Cumulative implant survival rates and success rates were 97.5% (95% confidence interval (CI): 94.5% to 98.9%) and 97.2% (95% CI: 94.2% to 98.7%), respectively, over a maximum follow-up period of 36 months, with no difference between Ti-Zr NDIs and commercial pure titanium (cpTi) implants. Cumulative mean (SD) MBL was 0.44 (0.04) mm (95% CI: 0.36 to 0.52) after one year. Meta-analysis of MBL indicated a mean difference of 0.02 mm (95% CI: -0.23 to 0.10), with no differences between Ti-Zr NDIs and cpTi implants. Short-term results of Ti-Zr NDIs for single-crown restorations are quite promising, although the number of published studies and follow-up periods are insufficient to determine the real benefit for single crowns. Long-term, follow-up clinical studies are needed to verify the excellent clinical performance of Ti-Zr NDIs.
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Affiliation(s)
- Rongkai Cao
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Beibei Chen
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Hui Xu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Zhen Fan
- Department of Oral Implantology, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China.
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Sbricoli L, Bazzi E, Stellini E, Bacci C. Systemic Diseases and Biological Dental Implant Complications: A Narrative Review. Dent J (Basel) 2022; 11:dj11010010. [PMID: 36661547 PMCID: PMC9857470 DOI: 10.3390/dj11010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
The relationship between periodontitis and such systemic disorders as diabetes, cardiovascular disease and obesity has been extensively investigated. There is less scientific evidence available, however, regarding the influence of systemic diseases on the risk of late failure of dental implant rehabilitation due to peri-implantitis. The aim of the present study was to review the literature on the role of several common systemic disorders (diabetes, obesity, cardiovascular disease, hypertension and osteoporosis) in the onset of peri-implantitis. A database search initially yielded 2787 studies of potential interest published up to 1 March 2022 (993 in PubMed; 908 in Web of Science; and 886 in Scopus). After removing 1190 duplicate articles and checking the titles, abstracts and full texts for relevance, 70 articles were selected for the present analysis. Only cohort, case-control studies and clinical case series were considered. Most of the literature concludes for no association between diabetes, cardiovascular disease, hypertension or osteoporosis and the risk of peri-implantitis. On the other hand, almost all the studies that investigated obesity as a risk factor for implant rehabilitation found a positive association between the two. Further longitudinal studies are needed to better understand the effects of systemic diseases on rehabilitation with dental implants.
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In Vitro and In Vivo Studies of Hydrogenated Titanium Dioxide Nanotubes with Superhydrophilic Surfaces during Early Osseointegration. Cells 2022; 11:cells11213417. [DOI: 10.3390/cells11213417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Titanium-based implants are often utilized in oral implantology and craniofacial reconstructions. However, the biological inertness of machined titanium commonly results in unsatisfactory osseointegration. To improve the osseointegration properties, we modified the titanium implants with nanotubular/superhydrophilic surfaces through anodic oxidation and thermal hydrogenation and evaluated the effects of the machined surfaces (M), nanotubular surfaces (Nano), and hydrogenated nanotubes (H-Nano) on osteogenesis and osseointegration in vitro and in vivo. After incubation of mouse bone marrow mesenchymal stem cells on the samples, we observed improved cell adhesion, alkaline phosphatase activity, osteogenesis-related gene expression, and extracellular matrix mineralization in the H-Nano group compared to the other groups. Subsequent in vivo studies indicated that H-Nano implants promoted rapid new bone regeneration and osseointegration at 4 weeks, which may be attributed to the active osteoblasts adhering to the nanotubular/superhydrophilic surfaces. Additionally, the Nano group displayed enhanced osteogenesis in vitro and in vivo at later stages, especially at 8 weeks. Therefore, we report that hydrogenated superhydrophilic nanotubes can significantly accelerate osteogenesis and osseointegration at an early stage, revealing the considerable potential of this implant modification for clinical applications.
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Diehl D, Winkler M, Bilhan H, Friedmann A. Implant stability of narrow diameter implants in hyperglycemic patients-A 3-month case-control study. Clin Exp Dent Res 2022; 8:969-975. [PMID: 35578391 PMCID: PMC9382047 DOI: 10.1002/cre2.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this prospective case-control study was to compare the development of implant stability quotients of narrow diameter implants in patients with type 2 diabetes mellitus (T2DM) and healthy individuals within the first 3 months after implant insertion. METHODS Sixteen patients with T2DM (HbA1C > 6.5%) as test group and 16 nondiabetic patients (HbA1C < 5.9%) as the control group were evaluated. All patients received narrow-diameter tissue level implants in an edentulous area posterior to the canine. The implant stability was measured by means of resonance frequency analysis after 3 days, 7 days, 4 weeks, and 3 months postplacement. Statistical analysis of intergroup differences and correlation to HbA1c values and treated jaw was performed in PRISM 8. RESULTS The means for implant stability quotients showed a significant increase between Day 3 and 3-month assessment in both groups. No significant differences between study groups and no correlation of implant stability to HbA1c were found. CONCLUSION The present study shows encouraging clinical outcomes for narrow-diameter implants inserted in the posterior zone in patients with uncontrolled T2DM.
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Affiliation(s)
- Daniel Diehl
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Institute of Pharmacology and Toxicology, Center for Biomedical Education and Research (ZBAF), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Marianna Winkler
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Hakan Bilhan
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anton Friedmann
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Dioguardi M, Cantore S, Scacco S, Quarta C, Sovereto D, Spirito F, Alovisi M, Troiano G, Aiuto R, Garcovich D, Crincoli V, Laino L, Covelli M, Malcangi A, Lo Muzio L, Ballini A, Di Cosola M. From Bench to Bedside in Precision Medicine: Diabetes Mellitus and Peri-Implantitis Clinical Indices with a Short-Term Follow-Up: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12020235. [PMID: 35207724 PMCID: PMC8878354 DOI: 10.3390/jpm12020235] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background and objective: Diabetes mellitus (DM) refers to a group of metabolic disorders characterized by hyperglycemia resulting from impaired secretion or action of insulin. The high levels of glucose in the blood can negatively affect the healing processes through alterations in vascularization, bone remodeling, and with increased susceptibility to infections. Diabetes mellitus is therefore a risk factor not only for many systemic diseases, but also for localized problems such as peri-implantitis. The objective of this systematic review was to identify a clear relationship between peri-implant inflammation indices and glycemic levels, through the investigation of prospective studies that report data on a short-term follow-up period. Our hypothesis was that peri-implant inflammatory indices may already present themselves in a statistically significant way as altered in patients with DM compared to patients without DM. Materials and methods: This review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Results: More than 992 records were identified in the PubMed, Scopus, and Cochrane Central Register of Controlled Trial electronic databases and only seven studies were included in the meta-analysis. The results of the meta-analysis report worse outcomes in patients with DM, even in the short period of six months, for peri-implatitis inflammation indices, such as Marginal bone loss (standardized (Std). mean difference (MD) 12\6 months 0.81 [0.45, 1.17]\1.82 [0.53, 3.10]), Bleeding on probing (Std. MD 12\6 months 2.84 [1.34, 4.34]\3.44 [1.41, 5.50]), Probing depth (Std. MD 12\6 months 1.14 [0.60, 1.68]\2.24 [0.66, 3.83]), and the plaque index (Std. MD 12 months 2.83 [0.09, 5.57]). Conclusion: The literature linking glycaemic control to peri-implant disease is highly heterogeneous due to lack of consistency of the definition of peri-implantitis and its clinical indicators among studies. Therefore, interpretation of finding and relevance to clinical practice should be considered on individual bases. In the era of personalized medicine, the clinician should utilize individualized information from translational researches and analyze all risk factors to provide the patient with evidence-based treatment options.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
| | - Stefania Cantore
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy;
- Faculty of Dentistry (Fakulteti i Mjekësisë Dentare-FMD), University of Medicine, 1001 Tirana, Albania
- Correspondence: (S.C.); (S.S.); (A.B.)
| | - Salvatore Scacco
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: (S.C.); (S.S.); (A.B.)
| | - Cristian Quarta
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, University of Turin, 10127 Turin, Italy;
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
| | - Riccardo Aiuto
- Department of Biomedical, Surgical, and Dental Science, University of Milan, 20122 Milan, Italy;
| | - Daniele Garcovich
- Department of Dentistry, Universidad Europea de Valencia, Paseo de la Alameda 7, 46010 Valencia, Spain;
| | - Vito Crincoli
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy;
| | - Michele Covelli
- Interuniversity Research Center “Population, Environment and Heath”—CIRPAS, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Annarita Malcangi
- Public Local Health Company (Azienda Sanitaria Locale, ASL), B.A.T, 76125 Trani, Italy;
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
| | - Andrea Ballini
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy;
- Faculty of Dentistry (Fakulteti i Mjekësisë Dentare-FMD), University of Medicine, 1001 Tirana, Albania
- School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Correspondence: (S.C.); (S.S.); (A.B.)
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (M.D.); (C.Q.); (D.S.); (F.S.); (G.T.); (L.L.M.); (M.D.C.)
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Friedmann A, Winkler M, Diehl D, Yildiz MS, Bilhan H. One-year performance of posterior narrow diameter implants in hyperglycemic and normo-glycemic patients-a pilot study. Clin Oral Investig 2021; 25:6707-6715. [PMID: 33939006 PMCID: PMC8602141 DOI: 10.1007/s00784-021-03957-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the study was to compare the performance of narrow diameter implants in patients with uncontrolled diabetes mellitus type 2 (T2DM) and normo-glycemic individuals during the first 12 months after implant loading. MATERIAL AND METHODS In 16 T2DM patients with HbA1C > 6.5% (test group) and 16 normo-glycemic patients (HbA1C < 6.0%; control group), one to two narrow diameter tissue level implants were placed in the posterior maxilla or mandible. After 3-month lasting integration period, implants were loaded by fixed dentures. The clinical parameters probing depth (PD), bleeding on probing (BOP), attachment loss (CAL), recession and papilla bleeding index (PBI) were assessed manually at loading and after 12 months of function. The paired digital periapical radiographs were analyzed with regard to the change in marginal bone level (MBL) from baseline to 12 months' control. The mean values calculated for both patient groups were statistically analyzed. The technical complications were recorded. RESULTS The T2DM group accounted 13 patients due to 3 dropouts. The overall implant survival rate after 12 months was 100%. The differences in means for the clinical parameters and the MBL were statistically non-significant between the T2DM and normo-glycemic patients for the short period of loaded function reported here. No technical complications were recorded. CONCLUSIONS The study demonstrated an encouraging clinical outcome with narrow diameter implants in patients with uncontrolled T2DM compared to non-diabetics after 12 months post loading. For the short observation period, no biological and technical complications were reported regardless the glycemic status. CLINICAL RELEVANCE Patients with HbA1C > 6.5% may benefit from the treatment with narrow diameter implants by avoiding complex surgical interventions with augmentation procedures. TRIAL REGISTRATION Clinicaltrials.gov : NCT04630691.
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Affiliation(s)
- Anton Friedmann
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen Str. 45, 58455 Witten, Germany
| | - Marianna Winkler
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen Str. 45, 58455 Witten, Germany
| | - Daniel Diehl
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen Str. 45, 58455 Witten, Germany
- Institute of Pharmacology and Toxicology, Center for Biomedical Education and Research (ZBAF), Faculty of Health, Witten/Herdecke University, Stockumer Straße 10, 58453 Witten, Germany
| | - Mehmet Selim Yildiz
- Department of Periodontology, Faculty of Dentistry, Altınbaş University, Zuhuratbaba, İncirli Cd. No:11-A, 34147 Bakırköy, Istanbul, Turkey
| | - Hakan Bilhan
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen Str. 45, 58455 Witten, Germany
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Latimer JM, Roll KL, Daubert DM, Zhang H, Shalev T, Wolff LF, Kotsakis GA. Clinical performance of hydrophilic, titanium-zirconium dental implantsin patients with well-controlled and poorly-controlledtype 2 diabetes: One-Year results of a dual-centerprospectivecohort study. J Periodontol 2021; 93:745-757. [PMID: 34738235 DOI: 10.1002/jper.21-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study assessed the clinical performance of hydrophilic dental implants in a patient cohort with type 2 diabetes mellitus (T2DM). METHODS Subjects with T2DM of ≥ 2-years duration were allocated to either the well-controlled (WC; HbA1c ≤ 7.0%,) or poorly-controlled (PC; 7.5 < HbA1c < 10%) groups in a dual-center, prospective cohort study. Each subject received a single, titanium-zirconium (Ti-Zr) dental implant with a chemically-modified, hydrophilic (modSLA) surface in a posterior mandibular site. Postoperatively, subjects were followed at 1, 2, 4, 8 and 12-week intervals. Post-loading, subjects were followed at 3, 6 and 12-months. Clinical and radiographic parameters of implant success, and dental patient-reported outcomes were collected. RESULTS Twenty-one dental patients (NWC = 11; NPC = 10; mean age: 66.8 ± 7.5 years) were enrolled and the 1-year implant success rate was 100%. Peri-implant bone levels were stable with 0.15 ± 0.06 mm mean marginal loss at one year without significant inter-group differences (p = 0.79). Postoperative pain was minimal at 1-week, and OHIP-5 scores decreased significantly over time as compared with preoperative levels (p < 0.001) suggesting significant improvement in patient-perceived oral health following implant therapy. CONCLUSIONS Elevated HbA1c levels> 7.5% did not compromise 1-year successrates, or oral health-related quality of lifein PC patients receiving modSLA, Ti-Zr implants. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jessica M Latimer
- Division of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
| | | | - Diane M Daubert
- Department of Periodontics, University of Washington School of Dentistry, Seattle, WA
| | - Hai Zhang
- Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, WA
| | - Tamir Shalev
- Department of Periodontology and Oral Implants, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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- Group Authorship; Study Collaborators are listed with their affiliations in the acknowledgements
| | - Larry F Wolff
- Division of Periodontology, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Georgios A Kotsakis
- Department of Periodontics, Director, Clinical and Translational Periodontal Research Lab., UTHealth San Antonio School of Dentistry, San Antonio, TX
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10
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Histomorphometric analysis of implant osseointegration using hydrophilic implants in diabetic rats. Clin Oral Investig 2021; 25:5867-5878. [PMID: 33765194 DOI: 10.1007/s00784-021-03892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate peri-implant bone formation of titanium implants using an in vivo rat model with and without uncontrolled diabetes mellitus (DM) to evaluate osseointegration of hydrophobic (Neoporos®) and hydrophilic (Acqua®) surfaces. MATERIALS AND METHODS 54 rats were divided into two groups: DM group (DMG) (streptozotocin-induced diabetes) and a control group (CG). Implants with hydrophobic (Neoporos®) and hydrophilic surfaces (Acqua®) were placed in the left or right tibia of animals. Animals were further divided into three groups (n = 9) euthanized after 7, 14, or 28 days. Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed in total, cortical, and medullary areas. RESULTS The DMG group, after a 7-day healing period, yielded with the Acqua implants presented significantly higher total BIC (+37.9%; p=0.03) and trabecular BIC (%) (+46.3%; p=0.02) values in comparison to the Neoporos implants. After 28 days of healing, the CG yielded that the cortical BAFO of Acqua implants to be significantly, 14%, higher (p=0.04) than Neoporos implants. CONCLUSION The positive effects of the Acqua surface were able to counteract the adverse impact of uncontrolled DM at early osseointegration periods. After 28 days in vivo, the metabolic systemic impairment caused by DM overcame the surface treatment effect, leading to impaired osseointegration in both hydrophilic and hydrophobic implants. CLINICAL RELEVANCE The adverse effects of diabetes mellitus with respect to bone healing may be minimized by deploying implants with strategically modified surfaces. This study evaluated the effects of implants with Acqua® and Neoporos® surfaces in both diabetic and healthy animals. During the initial healing period in diabetic animals, the hydrophilic surface was demonstrated to have beneficial effect on osseointegration in comparison to the hydrophobic surface. The results provide an insight into early healing, but the authors suggest that a future short-term and long-term clinical study is needed to assess the possible benefit of the Acqua® implant as well as in increasing the predictability of implant osseointegration.
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Jiang X, Zhu Y, Liu Z, Tian Z, Zhu S. Association between diabetes and dental implant complications: a systematic review and meta-analysis. Acta Odontol Scand 2021; 79:9-18. [PMID: 32401121 DOI: 10.1080/00016357.2020.1761031] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to explore the possible association between diabetes mellitus and dental implant complications. MATERIAL AND METHODS A systematic literature review was conducted to answer the following PICO (Participants, Intervention, Comparison, and Outcome) question: Is there association between diabetes mellitus and dental implant complications? Two independent searchers performed a literature search of the PubMed/MEDLINE, Web of Science, Cochrane Library and EMBASE databases for studies published until February 2020, focussing on studies including continuous outcomes, marginal bone loss (primary outcome), probing depth, and bleeding upon probing (secondary outcomes). RESULTS AND CONCLUSIONS A final total of 10 published studies were included in this systematic review. There were statistically significant differences between the groups with regard to marginal bone loss (p < .00001), probing depth (p < .00001) and bleeding around dental implants (p < .00001), and subjects without diabetes had lower complication rates. Additionally, in the subgroup analysis performed with loading time and HbA1c levels, a more evident association was found in immediate loading for probing depth. Moreover, the analysis results of bleeding around dental implants suggested that as HbA1c level increases, the bleeding of the tissues surrounding the implant will also increase. With regard to dental implant complications, there were statistically significant differences favouring patients without diabetes mellitus.
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Affiliation(s)
- Xue Jiang
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University, Changchun, Jilin, P.R. China
| | - Yanlin Zhu
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin, P.R. China
| | - Zhaoying Liu
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University, Changchun, Jilin, P.R. China
| | - Zilu Tian
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University, Changchun, Jilin, P.R. China
| | - Song Zhu
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University, Changchun, Jilin, P.R. China
- Department of Prosthodontics, Hospital of stomatology, Jilin University, Changchun, Jilin, P.R. China
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Hultin K, Eriksson A, Backe C, Johansson U, Bougas K. A Pilot Study with Randomised Controlled Design Comparing TiZr Alloy Dental Implants to Ti Implants. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e3. [PMID: 33598111 PMCID: PMC7875101 DOI: 10.5037/jomr.2020.11403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
Objectives Evidence on the clinical performance of recently introduced dental implants in titanium-zirconium alloy is sparse. The aim of the present pilot study with randomized controlled design is to compare changes in supporting structures around dental titanium-zirconium alloy implants to commercially pure titanium implants. Material and Methods The present material includes consecutive patients referred to a specialist clinic in Sweden. Two patient groups treated with dental implants in two different materials - titanium (Ti) and titanium-zirconium (TiZr) - were defined after block randomisation for smoking. In total, 40 implants installed in 21 patients were available for one-year follow-up. Marginal bone level, soft tissue height and width of keratinised mucosa were registered at baseline and at one-year follow-up. Results At implant level, the test group (TiZr) yielded significant marginal bone loss (P < 0.001) after one year. Additionally, marginal bone loss after one year was significantly higher for TiZr implants (P < 0.001) as compared to traditional Ti implants. Soft tissue dimensions were stable throughout the evaluation time for both implant materials. Conclusions One-year results indicate more pronounced initial marginal bone loss for dental implants in titanium-zirconium alloy as compared to implants made of commercially pure titanium.
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Affiliation(s)
- Kristina Hultin
- Department of Prosthodontics, Södra Älvsborg Hospital, BoråsSweden
| | - Annelie Eriksson
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, BoråsSweden
| | - Christina Backe
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, BoråsSweden
| | - Ulf Johansson
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, BoråsSweden
| | - Kostas Bougas
- Department of Periodontology, Södra Älvsborg Hospital, BoråsSweden
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