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Arribas AR, Galbraith BS, Wong ME. The Effect of Medical Status on Long Term Survival of Dental Implants. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00062-1. [PMID: 39266368 DOI: 10.1016/j.coms.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
Successful dental implant therapy relies on a bone-implant interface that is mechanically strong and capable of dynamic remodeling in response to functional loads. There are a number of medical conditions or therapies that can affect either bone metabolism or the resistance of bone to infection. However, their effects are often mitigated by local factors or individual responses so the impact of these conditions is not clear-cut. This article will review a number of these conditions and therapies and describe existing studies that have studied these conditions to guide practitioners in their implant practice.
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Affiliation(s)
- Alfredo R Arribas
- Katz Department of Oral & Maxillofacial Surgery, UTHealth Houston School of Dentistry, 7500 Cambridge Street Suite 6510, Houston, TX 77054, USA
| | - Bristol S Galbraith
- Katz Department of Oral & Maxillofacial Surgery, UTHealth Houston School of Dentistry, 7500 Cambridge Street Suite 6510, Houston, TX 77054, USA
| | - Mark E Wong
- Katz Department of Oral & Maxillofacial Surgery, UTHealth Houston School of Dentistry, 7500 Cambridge Street Suite 6510, Houston, TX 77054, USA.
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Mosaddad SA, Talebi S, Keyhan SO, Fallahi HR, Darvishi M, Aghili SS, Tavahodi N, Namanloo RA, Heboyan A, Fathi A. Dental implant considerations in patients with systemic diseases: An updated comprehensive review. J Oral Rehabil 2024; 51:1250-1302. [PMID: 38570927 DOI: 10.1111/joor.13683] [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: 03/30/2023] [Revised: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.
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Affiliation(s)
- Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Conservative Dentistry and Bucofacial Prosthesis, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Sahar Talebi
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seied Omid Keyhan
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Hamid Reza Fallahi
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Mohammad Darvishi
- Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Tavahodi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Fathi
- Department of Prosthodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Giok KC, Veettil SK, Menon RK. Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases. J Dent 2024; 146:105065. [PMID: 38762079 DOI: 10.1016/j.jdent.2024.105065] [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: 04/19/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES To perform a comprehensive quantitative and qualitative analysis of the findings from previously published meta-analyses and to assess existing biases. DATA/SOURCES A search was conducted for meta-analyses of observational studies investigating the association between any risk factor and peri‑implantitis in PubMed, Scopus, Cochrane Database of Systematic Reviews, and Epistemonikos, from inception until October 2023 (PROSPERO: CRD42024512408). STUDY SELECTION From a total of 5002 publications, 51 full-text articles were evaluated for eligibility, and 12 articles that described 41 unique meta-analyses evaluating the association between risk factors and periimplantitis were selected. Among 41 associations, 24 associations were significant. None of the associations were graded as convincing evidence. Two associations, presence of periodontitis (OR = 3.84 [95 % CI 2.58,5.72]) and cigarette smoking (RR=2.07 [95 % CI 1.41,3.04]) were graded as highly suggestive. Eight associations, diabetes mellitus, hyperglycaemia, lack of prophylaxis, history of chronic periodontal disease, ongoing or history of periodontal disease, implants located in the anterior region of the jaw (maxillary and mandibular), osteoprotegerin (OPG) gene polymorphisms, and lack of keratinized mucosal width were graded as suggestive evidence. CONCLUSIONS Periodontitis and cigarette smoking are highly suggestive risk factors for peri‑implantitis. The remaining risk factors which are suggestive require more high-quality studies to be performed to upgrade the level of evidence. CLINICAL SIGNIFICANCE The highly suggestive and suggestive risk factors for peri‑implantitis summarized in this umbrella review should be rigorously assessed, monitored and managed by clinicians to reduce the risk peri‑implantitis, as well as to form part of the preoperative consent process.
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Affiliation(s)
- Koay Chun Giok
- School of Dentistry, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajesh K Veettil
- School of Pharmacy, Department of Pharmacy Practice, College of pharmacy, International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Rohit Kunnath Menon
- Prosthodontics, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
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4
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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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Vilela N, Gurgel BCV, Bruzos CD, Duarte WR, da Silva HDP, Pannuti CM, Duarte PM. Preloading peri-implant crestal bone loss: A retrospective study of incidence and related factors. J Periodontol 2024. [PMID: 38923568 DOI: 10.1002/jper.24-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 04/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient-related and implant-related factors associated with PLCBL. METHODS This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm. RESULTS A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11-3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73-6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57-6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16-3.73), with bone-level platform-abutment connection (OR = 4.73, 95% CI = 1.94-11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84-7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28-0.84). CONCLUSION The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone-level platform-abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor.
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Affiliation(s)
- Nathalia Vilela
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Bruno C V Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Carlos De Bruzos
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Wagner R Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Hélio D P da Silva
- Department of Dentistry, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Claudio M Pannuti
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Enteghad S, Shirban F, Nikbakht MH, Bagherniya M, Sahebkar A. Relationship Between Diabetes Mellitus and Periodontal/Peri-Implant Disease: A Contemporaneous Review. Int Dent J 2024; 74:426-445. [PMID: 38614881 PMCID: PMC11123523 DOI: 10.1016/j.identj.2024.03.010] [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: 08/27/2023] [Revised: 02/11/2024] [Accepted: 03/17/2024] [Indexed: 04/15/2024] Open
Abstract
The prevalence of diabetes mellitus (DM), a major chronic disease and a leading cause of death and disability around the world, is rising. According to the latest data, the global prevalence of DM has increased to 463 million (9.3% of adults) in 2019 and is estimated to reach 700 million by 2045. Periodontal disease, result of periodontium inflammation, is a common, chronic disease and has long been considered one of the complications of DM. Moreover, literature reflects a spectrum of conflicting viewpoints on the effect of diabetic conditions on the implant treatment strategies. The current review aims to update the recent epidemiologic evidence regarding the relationship between DM and periodontal/peri-implant disease, emphasising the effects of glycaemic control on the severity of these diseases and describing the pathobiological mechanisms underlying this association. This review's findings indicate a bidirectional relationship between DM and periodontal/peri-implant disease and that this relationship seems causal, implying that controlling these two diseases might help prevent each other's incidence. Additionally, the severity of periodontal/peri-implant disease is directly related to metabolic control. Although patients with diabetes can obtain implant success similar to those in systemically healthy individuals, an increased risk of peri-implantitis has been reported in DM patients. Therefore, the importance of glycaemic control and maintaining proper oral hygiene cannot be overstated.
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Affiliation(s)
- Shabnam Enteghad
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farinaz Shirban
- Department of Orthodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - Mohammad Bagherniya
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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7
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Perussolo J, Donos N. Maintenance of peri-implant health in general dental practice. Br Dent J 2024; 236:781-789. [PMID: 38789755 PMCID: PMC11126374 DOI: 10.1038/s41415-024-7406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
The long-term maintenance or restoration of peri-implant tissues' health depends on the strategic implementation of preventive measures and interventions. These measures should be initiated before implant placement and continued throughout a patient's lifetime, as part of a tailored and comprehensive supportive peri-implant care (SPIC) programme. Central to the clinical efforts of maintaining and rehabilitating peri-implant tissues are several key factors, including the ongoing assessment and frequent monitoring of tissue health and stability, proactive oral health promotion, the control of risk factors and indicators and the provision of professional plaque biofilm removal. It is of paramount importance to underline that SPIC should not limit its scope exclusively to patients already in a state of peri-implant health; in fact, it is imperative that it should extend its protective effect to individuals who have been previously diagnosed and treated for peri-implant diseases, focusing on preventing its recurrence and progression, thereby avoiding further complications, such as implant loss.This narrative review presents an overview of the current literature on the maintenance of peri-implant tissues' health and the steps of SPIC providing insights into the critical factors to be considered when managing dental implant patients in the general dental practice.
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Affiliation(s)
- Jeniffer Perussolo
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK.
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8
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Insua A, Galindo-Moreno P, Miron RJ, Wang HL, Monje A. Emerging factors affecting peri-implant bone metabolism. Periodontol 2000 2024; 94:27-78. [PMID: 37904311 DOI: 10.1111/prd.12532] [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: 05/03/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.
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Affiliation(s)
- Angel Insua
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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9
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Guabello G, Zuffetti F, Ravidà A, Deflorian M, Carta G, Saleh MHA, Serroni M, Pommer B, Watzek G, Francetti L, Testori T. Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress. Periodontol 2000 2023; 92:329-349. [PMID: 37350348 DOI: 10.1111/prd.12503] [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: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.
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Affiliation(s)
- Gregorio Guabello
- Endocrinology Unit, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Francesco Zuffetti
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
| | - Andrea Ravidà
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Matteo Deflorian
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
| | - Giorgio Carta
- Argo Academy International Research Bologna, Bologna, Italy
- Private Practice, Bologna, Italy
- Lake Como Institute, Como, Italy
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Matteo Serroni
- Department of Innovative Technologies in Medicine & Dentistry, University 'G. D'Annunzio', Chieti-Pescara, Italy
| | - Bernhard Pommer
- Academy for Oral Implantology, Vienna, Austria
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Luca Francetti
- IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Tiziano Testori
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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10
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Li Y, Lu Z, Sun H. Impact of diabetes mellitus on the poor prognosis in patients with osseointegrated dental implants: a meta-analysis of observational studies. Biotechnol Genet Eng Rev 2023:1-19. [PMID: 36876980 DOI: 10.1080/02648725.2023.2184922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
This meta-analysis aimed to explore the correlation between diabetes mellitus (DM) and peri-implant diseases in patients with osseointegrated dental implants. Relevant studies were searched in multiple databases from the available date of inception through 26 August 2021. The odds ratios (ORs) were used as the effect indicator for measurement data, and each effect size was given estimates and 95% confidence intervals (CIs). Begg's test was used for publication bias. Twenty-one observational studies with 24,953 participants were selected. No significant association was shown between DM and peri-implant mucositis (OR: 0.739, 95% CI: 0.394-1.383, P = 0.344). The results demonstrated that the risk of peri-implantitis was higher in DM than in non-DM (OR: 1.553, 95% CI: 1.084-2.226, P = 0.016). Smokers had higher risk of peri-implantitis than non-smoking patients (OR: 1.754, 95% CI: 1.620-1.899, P < 0.001). In addition, no significant association was shown between DM and peri-implantitis among non-smokers. The association between periodontal history (OR: 2.538, 95% CI: 0.814-7.921, P = 0.109), poor plaque control (OR: 1.700, 95% CI: 0.334-8.648, P = 0.523) and peri-implantitis was not statistically significant. No publication bias was observed for each outcome. DM increases the risk of poor outcomes in osseointegrated dental implant patients. The findings of the present study further elucidate the need for longitudinal investigations regarding risk variables that affects peri-implant tissues.
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Affiliation(s)
- Yang Li
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhanyi Lu
- JiangBei Stomatological Center, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huachang Sun
- Stomatology Department, Jiangsu Provincial Hospital on Integration of Chinese and Western Medicine Jiangsu, NanJing, China
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11
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In-Vitro Evaluation of Photofunctionalized Implant Surfaces in a High-Glucose Microenvironment Simulating Diabetics. J Funct Biomater 2023; 14:jfb14030130. [PMID: 36976054 PMCID: PMC10056823 DOI: 10.3390/jfb14030130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
The present study aimed to assess the efficacy of photofunctionalization on commercially available dental implant surfaces in a high-glucose environment. Discs of three commercially available implant surfaces were selected with various nano- and microstructural alterations (Group 1—laser-etched implant surface, Group 2—titanium–zirconium alloy surface, Group 3—air-abraded, large grit, acid-etched surface). They were subjected to photo-functionalization through UV irradiation for 60 and 90 min. X-ray photoelectron spectroscopy (XPS) was used to analyze the implant surface chemical composition before and after photo-functionalization. The growth and bioactivity of MG63 osteoblasts in the presence of photofunctionalized discs was assessed in cell culture medium containing elevated glucose concentration. The normal osteoblast morphology and spreading behavior were assessed under fluorescence and phase-contrast microscope. MTT (3-(4,5 Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and alizarin red assay were performed to assess the osteoblastic cell viability and mineralization efficiency. Following photofunctionalization, all three implant groups exhibited a reduced carbon content, conversion of Ti4+ to Ti3+, increased osteoblastic adhesion, viability, and increased mineralization. The best osteoblastic adhesion in the medium with increased glucose was seen in Group 3. Photofunctionalization altered the implant surface chemistry by reducing the surface carbon content, probably rendering the surfaces more hydrophilic and conducive for osteoblastic adherence and subsequent mineralization in high-glucose environment.
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12
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Leung KCM, Chu CH. Dental Care for Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:214. [PMID: 36612536 PMCID: PMC9819414 DOI: 10.3390/ijerph20010214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
There is a global increase in the older population. Unfortunately, dental conditions in the older population can sometimes be poor as a result of worsened physical conditions and the cumulative damage caused by dental diseases in the past. Many suffer from oral diseases such as dental caries and periodontal disease but receive no regular dental care. Oral conditions and systemic problems are interrelated. Chronic medical problems and polypharmacy are common among them. These conditions may lead to xerostomia with or without a decrease in saliva output. Additionally, many older adults have deteriorated masticatory function associated with physical health issues such as frailty. Preventive measures are crucial to stop oral diseases from progressing and the replacement of missing teeth is needed when masticatory function is impaired. Older adults also suffer a higher risk of oral cancer because of their less resilient but more permeable oral mucosa. With the increasing need for elderly dental care, dentists should equip themselves with knowledge and skills in geriatric dentistry. They should help older adults to develop and maintain the functional ability that enables well-being in older age. This communication article aims to discuss the relevant medical conditions, common dental diseases, and dental care for older adults.
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Tan SJ, Baharin B, Mohd N, Nabil S. Effect of Anti-Diabetic Medications on Dental Implants: A Scoping Review of Animal Studies and Their Relevance to Humans. Pharmaceuticals (Basel) 2022; 15:ph15121518. [PMID: 36558969 PMCID: PMC9784528 DOI: 10.3390/ph15121518] [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: 11/08/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Animal studies have ascertained that hyperglycemia adversely affects bone metabolism and dental implant osseointegration. However, diabetic patients show low occurrence of unfavorable hard or soft peri-implant tissue changes, differences that are possibly due to treatment with anti-diabetic medications. This scoping review aimed to systematically examine the effects of these drugs on implant outcomes and explore the predictive modality of animal studies for clinical practice according to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Three electronic databases (MEDLINE, EBSCOHost, and Cochrane) were searched according to the PRISMA-ScR standards for studies on diabetic animals that received titanium implants and anti-diabetic treatments. Risk assessment was performed using the SYRCLE Risk-of-Bias (RoB) tool. Twenty-one papers were included, encompassing six types of medications. Fifteen studies were on T1DM animals, and only six involved T2DM models. T1DM animals were treated with non-insulin drugs in four investigations, while insulin was utilized in 11 other studies. In T2DM experiments, five administered non-insulin drugs, and only one applied locally delivered insulin. Only insulin in T1DM studies produced a positive influence on bone-implant contact (BIC), bone mineral content, and removal torque values. Inappropriate drug selection, inadequate glycemic control, and high RoB depict a mismatch between the research focus and the translational rationale to clinical practice. There remains a knowledge gap regarding T2DM investigations due to the lack of studies. More data are needed concerning intraoral implants and the performance of osseointegrated implants in patients with a later onset of diabetes. Future research should reflect the pathophysiology and treatment of each type of diabetes to ensure clinical applicability.
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Affiliation(s)
- Sze Jun Tan
- KPJ Ambulatory Care Centre Kinrara, 33, 35 & 37, Jalan BK 5a/2, Bandar Kinrara, Puchong 47180, Malaysia
| | - Badiah Baharin
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Correspondence:
| | - Nurulhuda Mohd
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Syed Nabil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
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14
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Herrero F, de Souza RF, Feine JS, Alexander PP, Green AV, Oates TW. The impact of implant-retained overdentures on type-2 diabetic and non-diabetic edentulous patients: Satisfaction and quality of life in a prospective cohort study. J Dent 2022; 127:104357. [PMID: 36351489 PMCID: PMC9691604 DOI: 10.1016/j.jdent.2022.104357] [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: 05/31/2022] [Revised: 09/07/2022] [Accepted: 11/04/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the benefits of implant therapy for patients with diabetes, we compared (i) healthy, (ii) well controlled T2DM and (iii) poorly controlled T2DM patients, in terms of oral health-related quality of life (OHRQoL) and satisfaction with mandibular 2-implant overdentures over 12 months following restoration. MATERIALS AND METHODS This single-center, prospective, cohort study recruited 165 edentulous adults (HbA1c<12%) to receive two endosseous implants in the anterior mandible to support mandibular overdentures. Participants were enrolled as having T2DM or not, with T2DM participants divided according to HbA1c into well-controlled (<8.1%) and poorly controlled (≥ 8.1%) groups. Participants provided responses to the OHIP-20 (OHRQoL) and the McGill Denture Satisfaction Questionnaire, before implant therapy and 6 and 12 months after overdenture insertion using Locator attachments. HbA1c was measured at the same time points. The effect of groups and time was verified using generalized estimating equations (α=0.025). RESULTS At 12 months, 137 participants provided responses. The two diabetes groups showed improvements in OHRQoL to the same extent as the non-diabetic control group at both 6 and 12 months. Patient satisfaction showed similar improvements with no between-group differences and similar increases identified at 6 and 12 months. HbA1c was not affected by time or groups. CONCLUSIONS Dental implant therapy provided significant improvements in patient-perceived benefits of mandibular two-implant overdentures for T2DM individuals, which are similar to those found for healthy edentulous individuals. Importantly, those benefits extend to those individuals with poorly controlled glycaemia. The addition of 2-implant supported mandibular overdentures did not affect glycaemic status over 12 months following insertion. CLINICAL SIGNIFICANCE As risks for implant therapy relative to glycaemic status are better understood, this study documents that implant therapy may offer important benefits in QoL for T2DM patients independent of glycaemic status.
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Affiliation(s)
- Frances Herrero
- Department of Advanced Oral Sciences & Therapeutics, School of Dentistry, University of Maryland, Baltimore, United States
| | - Raphael F de Souza
- Oral Health and Society, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Jocelyne S Feine
- Oral Health and Society, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Peggy P Alexander
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, United States
| | - Adriana Vargas Green
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, United States
| | - Thomas W Oates
- Department of Advanced Oral Sciences & Therapeutics, School of Dentistry, University of Maryland, Baltimore, United States.
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15
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Valdez-Salas B, Castillo-Uribe S, Beltran-Partida E, Curiel-Alvarez M, Perez-Landeros O, Guerra-Balcazar M, Cheng N, Gonzalez-Mendoza D, Flores-Peñaloza O. Recovering Osteoblast Functionality on TiO2 Nanotube Surfaces Under Diabetic Conditions. Int J Nanomedicine 2022; 17:5469-5488. [PMID: 36426372 PMCID: PMC9680990 DOI: 10.2147/ijn.s387386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Titanium (Ti) and its alloys (eg, Ti6Al4V) are exceptional treatments for replacing or repairing bones and damaged surrounding tissues. Although Ti-based implants exhibit excellent osteoconductive performance under healthy conditions, the effectiveness and successful clinical achievements are negatively altered in diabetic patients. Concernedly, diabetes mellitus (DM) contributes to osteoblastic dysfunctionality, altering efficient osseointegration. This work investigates the beneficial osteogenic activity conducted by nanostructured TiO2 under detrimental microenvironment conditions, simulated by human diabetic serum. Methods We evaluated the bone-forming functional properties of osteoblasts on synthesized TiO2 nanotubes (NTs) by anodization and Ti6Al4V non-modified alloy surfaces under detrimental diabetic conditions. To simulate the detrimental environment, MC3T3E-1 preosteoblasts were cultured under human diabetic serum (DS) of two diagnosed and metabolically controlled patients. Normal human serum (HS) was used to mimic health conditions and fetal bovine serum (FBS) as the control culture environment. We characterized the matrix mineralization under the detrimental conditions on the control alloy and the NTs. Moreover, we applied immunofluorescence of osteoblasts differentiation markers on the NTs to understand the bone-expression stimulated by the biochemical medium conditions. Results The diabetic conditions depressed the initial osteoblast growth ability, as evidenced by altered early cell adhesion and reduced proliferation. Nonetheless, after three days, the diabetic damage was suppressed by the NTs, enhancing the osteoblast activity. Therefore, the osteogenic markers of bone formation and the differentiation of osteoblasts were reactivated by the nanoconfigured surfaces. Far more importantly, collagen secretion and bone-matrix mineralization were stimulated and conducted to levels similar to those of the control of FBS conditions, in comparison to the control alloy, which was not able to reach similar levels of bone functionality than the NTs. Conclusion Our study brings knowledge for the potential application of nanostructured biomaterials to work as an integrative platform under the detrimental metabolic status present in diabetic conditions.
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Affiliation(s)
- Benjamin Valdez-Salas
- Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Sandra Castillo-Uribe
- Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Ernesto Beltran-Partida
- Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Baja California, México
- Correspondence: Ernesto Beltran-Partida, Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Blvd. Benito Juárez y Calle de la Normal, Mexicali, Baja California, C.P. 21280, México, Email
| | - Mario Curiel-Alvarez
- Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Oscar Perez-Landeros
- Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Minerva Guerra-Balcazar
- Facultad de Ingeniería, División de Investigación y Posgrado, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Daniel Gonzalez-Mendoza
- Instituto de Ciencias Agrícolas, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Olivia Flores-Peñaloza
- Laboratorio de Biología Molecular y Cáncer, Instituto de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Baja California, México
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16
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Pinotti FE, Aron MAT, de Oliveira GJPL, Marcantonio E, Marcantonio RAC. Implants with hydrophilic surfaces equalize the osseointegration of implants in normo- and hyperglycaemic rats. Braz Dent J 2022; 33:71-77. [PMID: 36477967 PMCID: PMC9733365 DOI: 10.1590/0103-6440202204793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to evaluate the effect of a surface modified by blasting and acid attack and maintained in an isotonic solution compared to a machined surface on osseointegration in normo- and hyperglycaemic animals. Sixty-four animals were allocated into 4 groups with 16 animals each, and they were subdivided into two experimental periods (15 and 45 days), with 8 animals in each group. The groups were divided according to the type of implant that was installed in the animals' tibia and the animals' systemic condition: CM - Machined implants placed in Healthy animals; CH - Hydrophilic implants placed in Healthy animals, HM - Machined implants placed in animals with hyperglycaemia; HH- Hydrophilic implants installed in animals with hyperglycaemia. The following analyses were performed: biomechanical (removal torque), microtomographic (evaluation of the bone volume around the implants- BV/TV), and histomorphometric (evaluation of bone-implant contact BIC% and of the bone formation area between the threads BBT%). It was found that the implants with hydrophilic surfaces presented higher removal torques and quantities of BV/TV% and higher BIC% and BBT% values in normo- and hyperglycaemic animals. The results of this study indicated that the hydrophilic surface accelerates the osseointegration process (~ 15% BIC/BBT at 15-day period), especially in animals with hyperglycaemia. The hydrophilic surface equaled the osseointegration between normo- and hyperglycaemic animals, reversing the negative potential of hyperglycaemia on the osseointegration process.
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Affiliation(s)
- Felipe Eduardo Pinotti
- Department of Diagnosis and Surgery, São Paulo State University(Unesp), School of Dentistry, Araraquara, Brazil
| | | | | | - Elcio Marcantonio
- Department of Diagnosis and Surgery, São Paulo State University(Unesp), School of Dentistry, Araraquara, Brazil
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17
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Dharmarajan L, Prakash PSG, Appukuttan D, Crena J, Subramanian S, Alzahrani KJ, Alsharif KF, Halawani IF, Alnfiai MM, Alamoudi A, Kamil MA, Balaji TM, Patil S. The Effect of Laser Micro Grooved Platform Switched Implants and Abutments on Early Crestal Bone Levels and Peri-Implant Soft Tissues Post 1 Year Loading among Diabetic Patients-A Controlled Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101456. [PMID: 36295619 PMCID: PMC9609409 DOI: 10.3390/medicina58101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/24/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
Background and Objectives: The study aimed to compare the mean crestal bone level (CBL) and peri-implant soft tissue parameters in laser micro-grooved (LMG) platform switched implants and abutments (I&A) post 1 year of functional loading among non-diabetic and type II diabetic individuals. Materials and methods: Patients with an edentulous site having minimum bone height and width of ≥13 mm and ≥6 mm, respectively, were divided into two groups: (i) Non-diabetic-8 (control) and (ii) diabetic-8 (test). LMG Implants were placed and loaded immediately with a provisional prosthesis. Mean crestal bone level (MCBL) was evaluated radiographically at baseline and at 1 year. Peri-implant attachment level (PIAL) and relative position of the gingival margin (R-PGM) were recorded. Implant stability quotient (ISQ) level and implant survival rate (ISR) were evaluated at 1 year. Results: Early MCBL within the groups 1 year postloading was similar both mesially and distally (control-0.00 to 0.16 mm and 0.00 to 0.17 mm, respectively; test-0.00 to 0.21 mm and 0.00 to 0.22 mm, respectively) with statistical significance (p ≤ 0.003, p ≤ 0.001 and p ≤ 0.001, p ≤ 0.001, respectively). However, intergroup comparison showed no significant difference statistically in the MCBL in 1 year post functional loading. The peri-implant soft tissue parameters showed no significant difference between the groups. ISQ level between both groups did not reveal any significant changes (p ≤ 0.92), and ISR was 100%. Conclusions: LMG Implants resulted in minimal and comparable early crestal bone loss and soft tissue changes post 1 year of functional loading in moderately controlled diabetic and non-diabetic individuals, suggesting that this could be a reliable system for use in systemically compromised individuals.
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Affiliation(s)
- Lalli Dharmarajan
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India
| | - P. S. G. Prakash
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India
- Correspondence: (P.S.G.P.); (S.P.)
| | - Devapriya Appukuttan
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India
| | - Jasmine Crena
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India
| | - Sangeetha Subramanian
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Khalaf F. Alsharif
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Ibrahim F. Halawani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Mrim M. Alnfiai
- Department of Information Technology, College of Computers and Information Technology, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Ahmed Alamoudi
- Oral Biology Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mona Awad Kamil
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia
| | | | - Shankargouda Patil
- College of Dental Medicine, Roseman University of Health Science, South Jordan, UT 84095, USA
- Correspondence: (P.S.G.P.); (S.P.)
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18
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Moraschini V, Kischinhevsky ICC, Sartoretto SC, de Almeida Barros Mourão CF, Sculean A, Calasans-Maia MD, Shibli JA. Does implant location influence the risk of peri-implantitis? Periodontol 2000 2022; 90:224-235. [PMID: 35913455 DOI: 10.1111/prd.12459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peri-implantitis is characterized by nonreversible and progressive loss of supporting bone and is associated with bleeding and/or suppuration on probing. Peri-implant disease is considered as the main etiologic factor related to implant failure. Peri-implant disease has a pathogenesis similar to that of periodontal disease, both being triggered by an inflammatory response to the biofilm accumulation. Although the prevalence of peri-implantitis has been evaluated by several clinical studies with different follow-ups, there are currently little data on the impact of implant location and the prevalence of peri-implantitis. The aim of this review, therefore, was to summarize the evidence concerning the prevalence of peri-implantitis in relation to implant location and associated risk predictors. Even though most studies evaluating the prevalence of peri-implantitis in relation to implant location are cross-sectional or retrospective, they suggest that the occurrence of peri-implantitis is most prevalent in the anterior regions of the maxilla and mandible. Moreover, it seems that there is a higher prevalence of peri-implantitis in the maxilla than in the mandible.
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Affiliation(s)
- Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil.,Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | - Suelen Cristina Sartoretto
- Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Monica Diuana Calasans-Maia
- Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Jamil Awad Shibli
- Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, São Paulo, Brazil
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Patel V, Sadiq MS, Najeeb S, Khurshid Z, Zafar MS, Heboyan A. Effects of metformin on the bioactivity and osseointegration of dental implants: A systematic review. J Taibah Univ Med Sci 2022; 18:196-206. [PMID: 36398019 PMCID: PMC9643507 DOI: 10.1016/j.jtumed.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/08/2022] [Accepted: 07/03/2022] [Indexed: 12/18/2022] Open
Abstract
Dental implants are prosthetic devices that are surgically placed in direct contact with the jawbone to support intra-oral functions and esthetics. Diabetes mellitus may contribute to peri-implant bone loss. During the last few years, there have been attempts to reduce this bone loss and improve the survival rate of implants. Metformin, an anti-diabetic drug known for its osteogenic properties, is thought to prevent peri-implant bone loss in diabetic patients. Although several studies have been conducted to study metformin's effect on diabetic and non-diabetic study models, no systematic review has analyzed and summarized these studies critically. Therefore, the objectives of this systematic review were to summarize the outcomes of these studies and critically appraise them. Seven studies were included in this systematic review. Four studies used only animal models, two used both animal and cell culture models, and one used only cell culture studies. The general characteristics and outcomes of the included studies were summarized, and Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines were used to assess the quality of the animal studies. In vitro studies indicate that metformin may induce stem cells to undergo osteoblastic differentiation to produce a higher amount of bone and may also improve osseointegration. Nevertheless, several studies had potential sources of bias. Therefore, it is recommended that emphasis be placed on increasing the quality of future animal studies and human trials to determine the effects of metformin on the osseointegration of dental implants. Future studies are needed with adequate follow-up to evaluate the efficacy of metformin in improving the osseointegration of dental implants.
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20
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Wang Z, Chen T, Wu Z, Jiang X, Hou Q, Miao S, Xia R, Wang L. The dual-effects of PLGA@MT electrospun nanofiber coatings on promoting osteogenesis at the titanium-bone interface under diabetic conditions. J Mater Chem B 2022; 10:4020-4030. [PMID: 35506736 DOI: 10.1039/d2tb00120a] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The high failure risk of endosseous titanium implants under diabetes conditions appeals to strengthen the osteointegration on the titanium-bone (Ti-B) interface. Melatonin (MT) is a neurohormone involved in bone homeostasis, which can promote osteogenesis and inhibit ROS overproduction through multiple pathways, but its effects on the Ti-B interface in diabetes remain elusive. The biodegradable poly(lactic-co-glycolic acid) (PLGA) has excellent controlled and sustained release properties, low cytotoxicity, and biocompatibility. Our study fabricated a nanofiber in which MT was encapsulated in PLGA to generate a nanofiber coating on a polydopamine (PDA)-modified titanium surface using electrospinning technology. The surface characteristic showed that MT was fully encapsulated in the PLGA carrier, and PLGA@MT was strongly coupled to the titanium matrix. Furthermore, the PLGA@MT-Ti nanofiber could release MT for at least 30 days. In vitro cellular tests demonstrated that PLGA@MT-Ti directly stimulates osteogenesis on the Ti-B interface by activating the BMP-4/WNT pathway in a dose-dependent manner. The effect of suppressing diabetes-induced ROS overproduction and promoting cell proliferation was not proportional to the content of MT. In vivo experiments revealed that PLGA@MT-Ti screws promoted the bone formation and osteointegration in type 1 diabetes mellitus (T1DM) mice with tibial bone defects. Our findings demonstrate that PLGA@MT-Ti exerted dual effects through activating the BMP-4/WNT pathway and attenuating ROS overproduction to promote osteogenesis and osteointegration at the Ti-B interface, providing a novel strategy to fabricate biomaterial modification and biofunctionalization under diabetic conditions.
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Affiliation(s)
- Zijie Wang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Tingting Chen
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Zimei Wu
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Xingzhu Jiang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Qiaodan Hou
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Sikai Miao
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Ruihao Xia
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Lin Wang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China. .,Southern University of Science and Technology Hospital, Shenzhen, 518055, China
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21
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Sant’Anna HR, Casati MZ, Mussi MC, Cirano FR, Pimentel SP, Ribeiro FV, Corrêa MG. Peri-Implant Repair Using a Modified Implant Macrogeometry in Diabetic Rats: Biomechanical and Molecular Analyses of Bone-Related Markers. MATERIALS 2022; 15:ma15062317. [PMID: 35329768 PMCID: PMC8953263 DOI: 10.3390/ma15062317] [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: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023]
Abstract
DM has a high prevalence worldwide and exerts a negative influence on bone repair around dental implants. Modifications of the microgeometry of implants have been related to positive results in bone repair. This study assessed, for the first time, the influence of an implant with modified macrodesign based on the presence of a healing chamber in the pattern of peri-implant repair under diabetic conditions. Thirty Wistar rats were assigned to receive one titanium implant in each tibia (Control Implant (conventional macrogeometry) or Test Implant (modified macrogeometry)) according to the following groups: Non-DM + Control Implant; Non-DM + Test Implant; DM + Control Implant; DM + Test Implant. One month from the surgeries, the implants were removed for counter-torque, and the bone tissue surrounding the implants was stored for the mRNA quantification of bone-related markers. Implants located on DM animals presented lower counter-torque values in comparison with Non-DM ones, independently of macrodesign (p < 0.05). Besides, higher biomechanical retention levels were observed in implants with modified macrogeometry than in the controls in both Non-DM and DM groups (p < 0.05). Moreover, the modified macrogeometry upregulated OPN mRNA in comparison with the control group in Non-DM and DM rats (p < 0.05). Peri-implant bone repair may profit from the use of implants with modified macrogeometry in the presence of diabetes mellitus, as they offer higher biomechanical retention and positive modulation of important bone markers in peri-implant bone tissue.
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22
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Saito N, Mikami R, Mizutani K, Takeda K, Kominato H, Kido D, Ikeda Y, Buranasin P, Nakagawa K, Takemura S, Ueno T, Hosaka K, Hanawa T, Shinomura T, Iwata T. Impaired dental implant osseointegration in rat with streptozotocin-induced diabetes. J Periodontal Res 2022; 57:412-424. [PMID: 35037248 DOI: 10.1111/jre.12972] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Few studies have reported on the impact of oxidative stress on the dental implant failure. The aim of this study was to investigate the impact of hyperglycemia-induced oxidative stress on dental implant osseointegration in diabetes mellitus (DM). METHODS Acid-treated titanium implants were bilaterally placed in the maxillary alveolar ridge of streptozotocin-induced diabetic (DM group) and control rats after extraction of first molars. Histological analysis and micro-push-out test were performed 4 weeks after surgery. Oxidative stress and osteogenic markers in the surrounding bone were quantified by real-time polymerase chain reaction. In the in vitro study, rat bone marrow-derived mesenchymal stem cells (BMMSCs) were cultured on acid-treated titanium discs in a high-glucose (HG) or normal environment. Intracellular reactive oxygen species (ROS), cell proliferation, alkaline phosphatase (ALP) activity, and extracellular calcification were evaluated following antioxidant treatment with N-acetyl-L-cysteine (NAC). RESULTS The implant survival rate was 92.9% and 75.0% in control and DM group, respectively. Bone-implant contact and push-out loads were significantly lower in the DM group. Expression of superoxide dismutase 1 at the mRNA level and on immunohistochemistry was significantly lower in the DM group. In vitro experiments revealed that the HG condition significantly increased ROS expression and suppressed the proliferation and extracellular calcification of BMMSCs, while NAC treatment significantly restored ROS expression, cell proliferation, and calcification. The ALP activity of both groups was not significantly different. CONCLUSION In diabetes, high-glucose-induced oxidative stress downregulates proliferation and calcification of BMMSCs, impairing osseointegration and leading to implant failure.
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Affiliation(s)
- Natsumi Saito
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risako Mikami
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiromi Kominato
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Daisuke Kido
- Oral Diagnosis and General Dentistry, Dental Hospital, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuichi Ikeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Prima Buranasin
- Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - Keita Nakagawa
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shu Takemura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takeshi Ueno
- Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keiichi Hosaka
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Regenerative Dental Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takao Hanawa
- Department of Metallic Biomaterials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tamayuki Shinomura
- Department of Tissue Regeneration, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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23
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Systematic review on diabetes mellitus and dental implants: an update. Int J Implant Dent 2022; 8:1. [PMID: 34978649 PMCID: PMC8724342 DOI: 10.1186/s40729-021-00399-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Dental implant surgery was developed to be the most suitable and comfortable instrument for dental and oral rehabilitation in the past decades, but with increasing numbers of inserted implants, complications are becoming more common. Diabetes mellitus as well as prediabetic conditions represent a common and increasing health problem (International Diabetes Federation in IDF Diabetes Atlas, International Diabetes Federation, Brussels, 2019) with extensive harmful effects on the entire organism [(Abiko and Selimovic in Bosnian J Basic Med Sci 10:186–191, 2010), (Khader et al., in J Diabetes Complicat 20:59–68, 2006, 10.1016/j.jdiacomp.2005.05.006)]. Hence, this study aimed to give an update on current literature on effects of prediabetes and diabetes mellitus on dental implant success. Methods A systematic literature research based on the PRISMA statement was conducted to answer the PICO question “Do diabetic patients with dental implants have a higher complication rate in comparison to healthy controls?”. We included 40 clinical studies and 16 publications of aggregated literature in this systematic review. Results We conclude that patients with poorly controlled diabetes mellitus suffer more often from peri-implantitis, especially in the post-implantation time. Moreover, these patients show higher implant loss rates than healthy individuals in long term. Whereas, under controlled conditions success rates are similar. Perioperative anti-infective therapy, such as the supportive administration of antibiotics and chlorhexidine, is the standard nowadays as it seems to improve implant success. Only few studies regarding dental implants in patients with prediabetic conditions are available, indicating a possible negative effect on developing peri-implant diseases but no influence on implant survival. Conclusion Dental implant procedures represent a safe way of oral rehabilitation in patients with prediabetes or diabetes mellitus, as long as appropriate precautions can be adhered to. Accordingly, under controlled conditions there is still no contraindication for dental implant surgery in patients with diabetes mellitus or prediabetic conditions.
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24
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Nourah D, Aldahlawi S, Andreana S. Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival. Curr Diabetes Rev 2022; 18:e060821195367. [PMID: 34365929 DOI: 10.2174/1573399817666210806120300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. AIM This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control. DISCUSSION Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. CONCLUSION In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.
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Affiliation(s)
- Dalia Nourah
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Salwa Aldahlawi
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
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25
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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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26
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Evaluating the osteogenic potential of insulin-like growth factor-1 microspheres on osteoblastic activity around dental implants in patients with type 2 diabetes mellitus using bone scintigraphy: A split-mouth randomized controlled trial. J Prosthet Dent 2021; 129:561-565. [PMID: 34294423 DOI: 10.1016/j.prosdent.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Dental implants are susceptible to early failure when placed in patients diagnosed with type 2 diabetes mellitus. The osteoinductive potential of insulin-like growth factor-1 (IGF-1) has been widely investigated in animals with type 2 diabetes mellitus, but studies investigating the osteoinductive potential of IGF-1 around dental implants in patients diagnosed with type 2 diabetes mellitus are lacking. PURPOSE This randomized controlled trial was conducted to assess the osteogenic efficacy of poly(lactide-co-glycolide)- (PLGA) encapsulated IGF-1 microspheres around dental implants placed in patients diagnosed with type 2 diabetes mellitus. MATERIAL AND METHODS A split-mouth, randomized controlled trial was conducted in 10 participants diagnosed with type 2 diabetes mellitus and with bilaterally missing mandibular posterior teeth. The 20 sites were randomly allotted to receive the PLGA encapsulated IGF-1 or placebo microspheres followed by the placement of Ø3.8×11-mm implants. Osteoblastic activity was quantitatively assessed with bone scintigraphy scanning on the thirtieth, sixtieth, and 90th day after implant placement. The Shapiro-Wilks test was used to analyze the normality of data, followed by the independent t test to compare the experimental and placebo groups. Intragroup comparison was performed by using repeated-measures ANOVA and the post hoc Bonferroni test (α=.05). RESULTS Statistical analysis revealed that the mean osteoblastic activity was higher in the experimental group which received the PLGA-encapsulated IGF-1 than in the placebo group at the 30th, 60th, and 90th day after implant placement (P≤.001). CONCLUSIONS This randomized controlled trial indicated that the PLGA-encapsulated sustained release of IGF-1 microspheres enhanced the process of osseointegration in patients diagnosed with type 2 diabetes mellitus until the 90th day after implant placement.
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27
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Liu L, Wang X, Zhou Y, Cai M, Lin K, Fang B, Xia L. The synergistic promotion of osseointegration by nanostructure design and silicon substitution of hydroxyapatite coatings in a diabetic model. J Mater Chem B 2021; 8:2754-2767. [PMID: 32196041 DOI: 10.1039/c9tb02882j] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Accumulating evidence indicates much higher failure rates for biomedical titanium implants in diabetic patients. This phenomenon is attributed to impaired osteoblastic function, suppressed angiogenesis capacity, and abnormal osteoclast activation in diabetic patients. Our previous study demonstrated that titanium implants coated with highly crystalline nanostructured hydroxyapatite (nHA) promoted the osteogenic differentiation of bone marrow stromal cells (BMSCs) and bone-implant osseointegration under healthy conditions. Furthermore, recent studies showed that silicon-substituted biomaterials exhibited excellent osteogenesis and angiogenesis performance while repressing osteoclastogenesis. Hence, we proposed that a combination of nanostructural modification and Si substitution might produce synergetic effects to mitigate the impaired osseointegration of bone implants under diabetes mellitus (DM) conditions. To confirm this hypothesis, titanium implants coated with highly crystalline Si-substituted nHA (Si-nHA) were successfully fabricated via atmospheric plasma spraying combined with hydrothermal treatment. An in vitro study demonstrated that compared to the original HA coating, the nHA coating improved osteogenic and angiogenic differentiation and altered the OPG/RANKL ratio of DM-BMSCs. In addition, the Si-nHA coating further enhanced cell proliferation, improved osteogenic and angiogenic differentiation, and repressed osteoclastogenesis in DM-BMSCs. An in vivo study confirmed that the titanium implants coated with nHA or Si-nHA effectively promoted bone formation and bone-implant osseointegration in a diabetic rabbit model, with the Si-nHA coating exhibiting the best stimulatory effect. Collectively, the results suggest that the nanostructured topography and Si substitution act synergistically to ameliorate the poor bone regeneration and osseointegration associated with DM. Thus, the results provide a promising coating method for dental and orthopedic applications under diabetic conditions.
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Affiliation(s)
- Lu Liu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Innovative Research Team of High-level Local Universities in Shanghai, Shanghai 200011, China. and National Clinical Research Center for Oral Diseases, Shanghai 200011, China. and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Xiuhui Wang
- Institute of Translational Medicine, Shanghai University, Shanghai 200011, China
| | - Yuning Zhou
- National Clinical Research Center for Oral Diseases, Shanghai 200011, China. and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China and Department of Oral Surgery, Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ming Cai
- National Clinical Research Center for Oral Diseases, Shanghai 200011, China. and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China and Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kaili Lin
- National Clinical Research Center for Oral Diseases, Shanghai 200011, China. and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China and Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Innovative Research Team of High-level Local Universities in Shanghai, Shanghai 200011, China. and National Clinical Research Center for Oral Diseases, Shanghai 200011, China. and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Innovative Research Team of High-level Local Universities in Shanghai, Shanghai 200011, China. and National Clinical Research Center for Oral Diseases, Shanghai 200011, China. and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
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Genetti L, Ercoli C, Kotsailidi EA, Feng C, Tsigarida A, Chochlidakis K. Clinical Evaluation of Crestal Bone Levels, Peri-Implant Indices, and Mucosal Margin Position of Immediately Impressed Posterior Dental Implants: A Cross-Sectional Study. J Prosthodont 2021; 30:763-768. [PMID: 33834572 DOI: 10.1111/jopr.13362] [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] [Accepted: 04/05/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This is a cross-sectional clinical study to evaluate crestal bone levels, mucosal margin position, probing depths, bleeding on probing, and plaque and bleeding indices of implants restored with an immediate impression workflow compared to implants restored with a delayed impression workflow. MATERIALS AND METHODS Patients who had received a posterior single implant crown in the premolar and molar regions were identified and scheduled for a single-visit study appointment. Outcome measurements included soft tissues peri-implant indices, peri-implant mucosal margin position, and crestal bone levels. Several systemic-, local-, and prosthesis-related factors were recorded. Bitewing radiographs were used to assess crestal bone levels. Wilcoxon rank sum test was used to compare the medians of continuous measurements and Pearson chi-square test (or Fisher's exact test) was used to compare the distributions of categorical variables between the two groups. RESULTS Twenty eight patients were included. Crestal bone levels, peri-implant mucosal margin position and peri-implant soft tissue parameters for the immediately impressed group were not statistically different from the delayed impressed group, except for probing depth for the immediately impressed buccal site, which was less than that of the delayed group. Mesial bone level for cement-retained crowns was significantly more coronal than for screw-retained ones. CONCLUSIONS While an isolated statistical difference was found in probing depth, the current study suggests that there is no clinically significant difference between implants impressed with immediate and delayed implant workflows when considering crestal bone levels, peri-implant mucosal margin position, and most peri-implant indices.
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Affiliation(s)
- Loren Genetti
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Carlo Ercoli
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.,Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Elli Anna Kotsailidi
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.,Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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29
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Korsch M, Marten SM, Stoll D, Prechtl C, Dötsch A. Microbiological findings in early and late implant loss: an observational clinical case-controlled study. BMC Oral Health 2021; 21:112. [PMID: 33706748 PMCID: PMC7948356 DOI: 10.1186/s12903-021-01439-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Implants are a predictable and well-established treatment method in dentistry. Nevertheless, looking at possible failures of dental implants, early and late loss have to be distinguished. The intent of the study was to report microbiological findings on the surface of implants with severe peri-implantitis, which had to be explanted. Methods 53 specimens of implants from 48 patients without severe general illnesses have been examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss, 13 patients with 14 implants) or after the healing period (late loss, 14 patients with 17 implants). The implant losses were compared with two control groups (implants with no bone loss directly after completed osseointegration, two to four months after implant placement (17 patients with 17 implants) and implants with no bone loss and prosthetic restoration for more than three years (5 patients with 5 implants)). Data about the bacteria located in the peri-implant sulcus was collected using amplification and high throughput sequencing of the 16S rRNA gene. Results The biofilm composition differed substantially between individuals. Both in early and late implant loss, Fusobacterium nucleatum and Porphyromonas gingivalis were found to be abundant. Late lost implants showed higher bacterial diversity and in addition higher abundances of Treponema, Fretibacterium, Pseudoramibacter and Desulfobulbus, while microbial communities of early loss implants were very heterogeneous and showed no significantly more abundant bacterial taxa. Conclusions Specific peri-implant pathogens were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nucleatum frequently colonized the implant in early and late losses and could therefore be characteristic for implant loss in general. In general, early lost implants showed also lower microbial diversity than late losses. However, the microbial results were not indicative of the causes of early and late losses.
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Affiliation(s)
- Michael Korsch
- Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135, Karlsruhe, Germany. .,Center for Implantology and Oral Surgery, Berliner Straße 41, 69120, Heidelberg, Germany. .,Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421, Homburg, Germany.
| | - Silke-Mareike Marten
- Institute of Functional Interfaces, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Dominic Stoll
- Department of Safety and Quality of Fruit and Vegetables, Max Rubner-Institut, Karlsruhe, Germany
| | - Christopher Prechtl
- Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135, Karlsruhe, Germany.,Center for Implantology and Oral Surgery, Berliner Straße 41, 69120, Heidelberg, Germany
| | - Andreas Dötsch
- Institute of Functional Interfaces, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
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30
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Shang R, Gao L. Impact of hyperglycemia on the rate of implant failure and peri-implant parameters in patients with type 2 diabetes mellitus: Systematic review and meta-analysis. J Am Dent Assoc 2021; 152:189-201.e1. [PMID: 33632408 DOI: 10.1016/j.adaj.2020.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of hyperglycemia on dental implant therapy remains unclear. In this systematic review and meta-analysis, the authors compared the rates of implant failure and peri-implant bleeding on probing (BOP), probing depth (PD), and peri-implant bone loss (PIBL) among patients with type 2 diabetes mellitus and nondiabetic patients. The authors performed subgroup analyses based on glycemic level to evaluate whether patients with higher glycemic levels were more prone to peri-implant inflammation. TYPE OF STUDIES REVIEWED The authors searched 4 databases for original clinical studies. Studies in which the researchers provided information on the rate of implant failure or peri-implant parameters were included. RESULTS Nine clinical studies were identified on the basis of the inclusion criteria. No significant differences were found in rates of implant failure (P = .46) and PD (P = .1) between diabetic and nondiabetic patients. Significant differences in BOP (P < .00001) and PIBL (P = .02), favoring nondiabetic patients, were observed. Results of subgroup analyses indicated that the increase in glycemic level did not significantly influence BOP, PD, and PIBL values among diabetic patients. CONCLUSIONS AND PRACTICAL IMPLICATIONS Patients with type 2 diabetes mellitus seem to be able to achieve a rate of implant survival similar to that of healthy patients. Regarding peri-implant parameters, BOP and PIBL were higher in patients with type 2 diabetes mellitus, indicating that hyperglycemia is an important risk factor for peri-implant inflammation. No association was found between peri-implant parameters and glycemic level among patients with type 2 diabetes mellitus, providing oral hygiene was strictly maintained.
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Tan SJ, Baharin B, Nabil S, Mohd N, Zhu Y. DOES GLYCEMIC CONTROL HAVE A DOSE-RESPONSE RELATIONSHIP WITH IMPLANT OUTCOMES? A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101543. [PMID: 34391557 DOI: 10.1016/j.jebdp.2021.101543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To comprehensively evaluate implant survival, clinical and biochemical parameters, as well as possible dose-response relationship with hemoglobin A1c (HbA1c) in patients with differing diabetic control. METHODOLOGY Five electronic databases were searched for studies that compared implant outcomes in patients with differing HbA1c values. Research quality was evaluated using Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Narrative synthesis and meta-analysis were performed for survival rate, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and marginal bone loss (MBL). Categorical dose-response meta-analysis (DRMA) was conducted according to length of follow-up. RESULTS Twenty-two studies met the inclusion criteria. Prospective studies were mostly of moderate quality, but non-prospective papers had serious to critical risk of bias. Survival rate was high for the first 3 years (92.6%-100%) for patients with HbA1c less than 8%. Meta-analysis revealed worsening clinical parameters with increasing HbA1c. DRMA further established a significant dose-response relationship between glycemic control with BOP (10% more bleeding, 95% CI 0.05-0.16, P = .008) and MBL (0.05 mm more bone loss, 95% CI 0.01-0.09, P = .002) per HbA1c category, but no association with probing pocket depth. Osseointegration progressed at a slower rate, and inflammatory cytokines and bone biomarkers were adversely affected in patients with HbA1c above 8%. CONCLUSION Moderate evidence suggests a high short-term survival but possible dose-response trend of worsening BOP and MBL in association with glycemic control. Clinically, HbA1c values must be considered for risk assessment before placement and throughout the lifespan of the implant placed in a patient with diabetes.
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Affiliation(s)
- Sze Jun Tan
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Badiah Baharin
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia.
| | - Syed Nabil
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nurulhuda Mohd
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Yingying Zhu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Khadembaschi D, Borgna SC, Beech N, Batstone MD. Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study. Int J Oral Maxillofac Surg 2021; 50:1375-1382. [PMID: 33642153 DOI: 10.1016/j.ijom.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022]
Abstract
The surgical management of head and neck pathologies involving the maxilla and mandible results in significant functional and aesthetic deficits, and ultimately reduced quality of life. Composite free flaps used for reconstruction address many of these deficits and create a foundation for the use of osseointegrated implants to support prosthetic replacement of the dentition. There are few comparative studies examining outcomes of implants in native and reconstructed bone in head and neck cancer patients. The aim of this retrospective cohort study was to compare survival rates and the effects of risk factors between implants placed in native and reconstructed bone. The Kaplan-Meier method estimated cumulative 1- and 5-year implant survival rates of 99.5% and 95% for native bone and 96% and 88% for reconstructed bone. Multivariate Cox regression found an increased risk of implant failure in reconstructed bone (hazard ratio (HR) 9.9, 95% confidence interval (CI) 3.4-29.7, P<0.001). Subgroup analysis of the cohorts found an increased risk of failure in the reconstructed group associated with radiotherapy (HR 6.4, 95% CI 1.8-22.3, P=0.004), current smoking (HR 23.2, 95% CI 2.7-198.6, P=0.004), and previous smoking (HR 9.0, 95% CI 1.1-71.9, P=0.038). There was no effect in the native bone group. Implants placed into reconstructed bone had higher rates of failure, and smoking status and radiotherapy increased the risk of implant failure.
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Affiliation(s)
- D Khadembaschi
- School of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - S C Borgna
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - N Beech
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - M D Batstone
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Zhang J, Wang YN, Jia T, Huang H, Zhang D, Xu X. Genipin and insulin combined treatment improves implant osseointegration in type 2 diabetic rats. J Orthop Surg Res 2021; 16:59. [PMID: 33446235 PMCID: PMC7809857 DOI: 10.1186/s13018-021-02210-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has a harmful effect on the stability and osseointegration of dental implants. T2DM induces mitochondrial damage by inhibiting AMPK signaling, resulting in oxidative stress and poor osteogenesis in the peri-implant bone area. Genipin is a major component of gardenia fruits with strong antioxidant, anti-inflammation, and antidiabetic actions, and it also can activate mitochondrial quality control via the AMPK pathway. The purpose of this study was to investigate the effects of genipin and insulin treatment on implant osseointegration in T2DM rats and explore the underlying mechanisms. METHODS Streptozotocin-induced diabetic rats received implant surgery in their femurs and were then assigned to five groups that were subjected to different treatments for three months: control group, T2DM group, insulin-treated T2DM group (10 IU/kg), genipin-treated T2DM group (50 mg/kg), and the genipin and insulin combination-treated T2DM group. Then, we regularly assessed the weight and glucose levels of the animals. Rats were euthanized at 3 months after the implantation procedure, and the femora were harvested for microscopic computerized tomography analysis, biomechanical tests, and different histomorphometric assessment. RESULTS The results indicated that the highest blood glucose and oxidative stress levels were measured for the T2DM group, resulting in the poorest osseointegration. The combination-treated T2DM group mitigated hyperglycemia and normalized, reactivated AMPK signaling, and alleviated oxidative stress as well as reversed the negative effect of osseointegration. There were beneficial changes observed in the T2DM-genipin and T2DM-insulin groups, but these were less in comparison to the combination treatment group. CONCLUSION Our study suggests that treatment with genipin in combination with insulin could be an effective method for promoting implant osseointegration in T2DM rats, which may be related to AMPK signaling.
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Affiliation(s)
- Jiajia Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Road West, Jinan, 250012, Shandong Province, China
| | - Ya-Nan Wang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Road West, Jinan, 250012, Shandong Province, China
| | - Tingting Jia
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Road West, Jinan, 250012, Shandong Province, China
| | - Haiyun Huang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Road West, Jinan, 250012, Shandong Province, China
| | - Dongjiao Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Road West, Jinan, 250012, Shandong Province, China.
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Road West, Jinan, 250012, Shandong Province, China.
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Abd-Ul-Salam H. Peri-implantitis. INNOVATIVE PERSPECTIVES IN ORAL AND MAXILLOFACIAL SURGERY 2021:47-59. [DOI: 10.1007/978-3-030-75750-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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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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Tang D, Wang E, Xu Y, Liang C, Liu C, Lin X, Li J. Is hyperglycemia the only risk factor for implant in type 2 diabetics during the healing period? Oral Dis 2020; 27:1551-1563. [PMID: 33078488 DOI: 10.1111/odi.13685] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine whether risk factors other than hyperglycemia lead to failed osseointegration in patients with type 2 diabetes mellitus (T2DM) during the healing period. MATERIALS AND METHODS We compared the success rates between patients with and without T2DM during the healing period at our center. Bone marrow mesenchymal stem cells (BMSCs) were cultured from subjects. Proteomics was used to detect differentially expressed proteins (DEPs) among the DM failure (DM-F), DM success (DM-S), and control (Con) groups. The correlation between the expression levels of nine target DEPs and medium glucose concentrations was investigated. RESULTS Higher failure rates were observed in the T2DM patients. Fifty-two DEPs were found between the DM-F and DM-S groups. Seventy-three DEPs were found between the DM-F and Con groups. Forty-three DEPs were found between the DM-S and Con groups. Five target DEPs were expressed at the same levels in the medium with different glucose concentrations. Gene ontology annotation and functional enrichment analysis suggest that the DEPs detected in the DM-F group may affect the biological function and regulatory potential of BMSCs. CONCLUSIONS The DEPs detected in the DM-F group can be intervention targets for to prevent implant failure in T2DM patients. Risk factors besides hyperglycemia may affect osseointegration during healing period.
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Affiliation(s)
- Dezheng Tang
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Entang Wang
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Yifan Xu
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Chao Liang
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Changying Liu
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Xiao Lin
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Jun Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
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Inoue M, Nakano T, Shimomoto T, Kabata D, Shintani A, Yatani H. Multivariate analysis of the influence of prosthodontic factors on peri-implant bleeding index and marginal bone level in a molar site: A cross-sectional study. Clin Implant Dent Relat Res 2020; 22:713-722. [PMID: 33179401 DOI: 10.1111/cid.12953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peri-implant tissue condition can result from prosthodontic, surgical and bacteriological factors. PURPOSE This study investigated the effects of prosthodontic factors on peri-implant tissue. MATERIALS AND METHODS Subjects were 140 patients with 310 implants from Osaka University Dental Hospital. Prosthodontic factors examined were the connection type, the suprastructure retention type, the material of the abutment and the mesiodistal and buccolingual prosthetic form of the superstructure as emergence angle. The objective variables were the modified bleeding index (mBI) and marginal bone level (MBL). Statistical analysis was used as a generalized estimation equation. RESULTS The taper joint had a significantly smaller MBL than the butt joint (P < .001). There was no significant difference in mBI and MBL between cement and screw retaining. Zirconium and titanium resulted in a significantly smaller mBI than gold alloy (zirconium/gold alloy: P = .037, titanium / gold alloy: P = .021), but there was no significant difference in the MBL. Both mBI and MBL tended to be smaller when the emergence angle was around 20° to 40°, although this difference was not significant. CONCLUSION As a result of multivariate analysis, our findings suggest that to reduce MBL from the perspective of prosthodontic factors it is preferable to use an implant with a taper joint connection positioned with an emergence angle of 20° to 40°.
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Affiliation(s)
- Masaki Inoue
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Tamaki Nakano
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takuya Shimomoto
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirofumi Yatani
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
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Hua Y, Bi R, Li Z, Li Y. Resveratrol treatment promotes titanium implant osseointegration in diabetes mellitus rats. J Orthop Res 2020; 38:2113-2119. [PMID: 32141632 DOI: 10.1002/jor.24651] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/04/2019] [Accepted: 03/01/2020] [Indexed: 02/05/2023]
Abstract
Type II diabetes mellitus (T2DM) is the most common metabolic disorder; it is characterized by hyperglycemia and causes implant failure by influencing implant osseointegration. Resveratrol promotes bone formation, but it is unclear if resveratrol improves implant osseointegration. Thirty 12-week-old Sprague-Dawley rats were divided into control (CTL), diabetes mellitus (DM), and resveratrol treatment (DM + Res) groups. In the DM and DM + Res groups (n = 10 each), T2DM was induced via streptozotocin injections; the remaining 10 rats were considered the CTL group. Eight weeks after the insertion of a rod-like Ti implant with a 12-mm length and 1-mm diameter in the left leg, the rats were euthanized. We analyzed implant osseointegration using microcomputed tomography (micro-CT), histological analyses, and biomechanical tests. The parameters showed that T2DM negatively influenced implant osseointegration in the tibia. Compared to that in the DM group, the bone loss of peri-implant bone mass in the DM + Res group was decreased significantly. However, resveratrol still did not induce the same level of implant osseointegration as that observed in the CTL group according to the histological and micro-CT analyses. These results indicated that resveratrol reduced the influence of DM in implant osseointegration, resulting in increased peri-implant bone density, improved trabecular architecture, and enhanced biomechanical fixation.
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Affiliation(s)
- Yunwei Hua
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zheru Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yunfeng Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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de Oliveira PGFP, de Melo Soares MS, Silveira E Souza AMM, Taba M, Palioto DB, Messora MR, Ghiraldini B, Nunes FADS, de Souza SLS. Influence of nano-hydroxyapatite coating implants on gene expression of osteogenic markers and micro-CT parameters. An in vivo study in diabetic rats. J Biomed Mater Res A 2020; 109:682-694. [PMID: 32608088 DOI: 10.1002/jbm.a.37052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022]
Abstract
This study evaluated the response of a nano-hydroxyapatite coating implant through gene expression analysis (runt-related transcription factor 2 (Runx2), alkaline phosphatase (Alp), osteopontin (Opn), osteocalcin (Oc), receptor activator of nuclear factor-kappa B (Rank), receptor activator of nuclear factor-kappa B ligand (Rank-L), and osteoprotegerin (Opg)). Three-dimensional evaluation (percent bone volume (BV/TV); percent intersection surface (BIC); bone surface/volume ratio (BS/BV); and total porosity (To.Po)) were also analyzed. Mini implants were surgically placed in tibias of both healthy and diabetic rats. The animals were euthanized at 7 and 30 days. Evaluating all factors the relative expression of Rank showed that NANO surface presented the best results at 7 days (diabetic rats). Furthermore the levels of Runx2, Alp, Oc, and Opn suggest an increase in osteoblasts proliferation, especially in early stages of osseointegration. %BIC in healthy and diabetic (7 days) depicted statistically significant differences for NANO group. BV/TV, BS/BV and To.Po demonstrated higher values for NANO group in all evaluated time point and irrespective of systemic condition, but BS/BV 30 days (healthy rat) and 7 and 30 days (diabetic rat). Microtomographic and gene expression analyses have shown the benefits of nano-hydroxyapatite coated implants in promoting new bone formation in diabetic rats.
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Affiliation(s)
| | - Mariana Sales de Melo Soares
- Department of Oral and Maxillofacial Surgery and Periodontology, FORP/USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Mário Taba
- Department of Oral and Maxillofacial Surgery and Periodontology, FORP/USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniela Bazan Palioto
- Department of Oral and Maxillofacial Surgery and Periodontology, FORP/USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Michel Reis Messora
- Department of Oral and Maxillofacial Surgery and Periodontology, FORP/USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruna Ghiraldini
- Paulista University, School of Dentistry, São Paulo, São Paulo, Brazil
| | - Felipe Anderson de Sousa Nunes
- Department of Oral and Maxillofacial Surgery and Periodontology, FORP/USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sérgio Luís Scombatti de Souza
- Department of Oral and Maxillofacial Surgery and Periodontology, FORP/USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Lops D, Stocchero M, Motta Jones J, Freni A, Palazzolo A, Romeo E. Five Degree Internal Conical Connection and Marginal Bone Stability around Subcrestal Implants: A Retrospective Analysis. MATERIALS 2020; 13:ma13143123. [PMID: 32668745 PMCID: PMC7411692 DOI: 10.3390/ma13143123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited information on the effect of the connection between subcrestally placed implants and abutments on marginal bone levels. The aim of the present retrospective study was to evaluate marginal bone levels after definitive prosthesis delivery around implants with an internal 5° conical connection placed in a subcrestal position. MATERIALS AND METHODS Patients treated with fixed prostheses supported by implants placed at a subcrestal level between 2012 and 2018 were recalled for a follow-up examination. All implants had 5° internal conical connection with platform switching. Radiographic marginal bone level (MBL) was measured. MBL change between prosthetic delivery (t0) and follow-up examination (t1) was calculated. A multiple regression model was performed to identify the most significant predictors on MBL change. RESULTS Ninety-three patients and 410 implants, with a mean follow-up of 2.72 ± 1.31 years, were examined. Mean MBL was -1.09 ± 0.65 mm and -1.00 ± 0.37 mm at t0 and t1, respectively, with a mean bone remodeling of 0.09 ± 0.68 mm. An implant's vertical position in relation to the bone crest, the year of follow up and the presence of type-2 controlled diabetes were demonstrated to be influencing factors for MBL modifications. CONCLUSIONS Subcrestally placed implants with platform switching and internal conical connection maintained stable bone levels over a mean follow-up of more than 2 years. How a tight internal conical connection between abutment and implant may contribute to this clinical evidence should be more deeply investigated. MBL variations seem to be mostly influenced by an implant's vertical position and presence of type-2 controlled diabetes.
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Affiliation(s)
- Diego Lops
- Department of Prosthodontics, Dental Clinic, School of Dentistry, University of Milan, 20142 Milan, Italy; (A.P.); (E.R.)
- Correspondence: ; Tel.: +39-0250319039; Fax: +39-0250319040
| | - Michele Stocchero
- Department of Neurosciences, University of Padova, 35128 Padua, Italy;
| | - Jason Motta Jones
- Department of Oral Surgery, Dental Clinic, Humanitas University, 20089 Milan, Italy;
| | | | - Antonino Palazzolo
- Department of Prosthodontics, Dental Clinic, School of Dentistry, University of Milan, 20142 Milan, Italy; (A.P.); (E.R.)
| | - Eugenio Romeo
- Department of Prosthodontics, Dental Clinic, School of Dentistry, University of Milan, 20142 Milan, Italy; (A.P.); (E.R.)
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Alberti A, Morandi P, Zotti B, Tironi F, Francetti L, Taschieri S, Corbella S. Influence of Diabetes on Implant Failure and Peri-Implant Diseases: A Retrospective Study. Dent J (Basel) 2020; 8:dj8030070. [PMID: 32635449 PMCID: PMC7559512 DOI: 10.3390/dj8030070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022] Open
Abstract
Diabetes is an important modifying factor of periodontitis, but its association with peri-implant diseases has not been fully explored and the existing literature reports controversial results. The aim of this retrospective study was to evaluate the influence of diabetes on peri-implantitis and implant failure. Smoking status, history of periodontal disease, presence of diabetes, diabetes type, therapy and glycaemia levels were collected in a total of 204 subjects treated with 929 implants, with a mean follow-up time of 5.7 ± 3.82 years after loading. Odds ratio (OR) for diabetes as a direct cause of peri-implantitis and implant failure were calculated, adjusted for smoking status and history of periodontitis. Nineteen patients were diabetic and most of them presented a good control of the disease at the time of surgery. The overall patient-level prevalence of peri-implantitis was 11.3%. Among diabetic patients, one developed peri-implantitis, whereas one experienced multiple implant failures. The calculated ORs, adjusted for smoking status and periodontitis, were not statistically significant. The results revealed no association between diabetes and peri-implantitis or implant failure coherently with the existing scientific literature. The actual influence of hyperglycemia on implant failure is still uncertain and new studies with larger cohorts of patients are needed.
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Affiliation(s)
- Alice Alberti
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
- Correspondence:
| | - Paolo Morandi
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
| | - Beatrice Zotti
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
| | - Francesco Tironi
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
- Department of Oral Surgery, Institute of Dentistry, I.M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Universitaà degli Studi di Milano, 20122 Milan, Italy; (P.M.); (B.Z.); (F.T.); (L.F.); (S.T.); (S.C.)
- IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
- Department of Oral Surgery, Institute of Dentistry, I.M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
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42
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Yan Y, Zhang H, Liu L, Chu Z, Ge Y, Wu J, Liu Y, Tang C. Periostin reverses high glucose-inhibited osteogenesis of periodontal ligament stem cells via AKT pathway. Life Sci 2020; 242:117184. [DOI: 10.1016/j.lfs.2019.117184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/07/2019] [Accepted: 12/16/2019] [Indexed: 01/29/2023]
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Xing H, Wang X, Xiao G, Zhao Z, Zou S, Li M, Richardson JJ, Tardy BL, Xie L, Komasa S, Okazaki J, Jiang Q, Yang G, Guo J. Hierarchical assembly of nanostructured coating for siRNA-based dual therapy of bone regeneration and revascularization. Biomaterials 2020; 235:119784. [PMID: 31981763 DOI: 10.1016/j.biomaterials.2020.119784] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 12/30/2022]
Abstract
Advancing bone implant engineering offers the opportunity to overcome crucial medical challenges and improve clinical outcomes. Although the establishment of a functional vascular network is crucial for bone development, its regeneration inside bone tissue has only received limited attention to date. Herein, we utilize siRNA-decorated particles to engineer a hierarchical nanostructured coating on clinically used titanium implants for the synergistic regeneration of skeletal and vascular tissues. Specifically, an siRNA was designed to target the regulation of cathepsin K and conjugated on nanoparticles. The functionalized nanoparticles were assembled onto the bone implant to form a hierarchical nanostructured coating. By regulating mRNA transcription, the coating significantly promotes cell viability and growth factor release related to vascularization. Moreover, microchip-based experiments demonstrate that the nanostructured coating facilitates macrophage-induced synergy in up-regulation of at least seven bone and vascular growth factors. Ovariectomized rat and comprehensive beagle dog models highlight that this siRNA-integrated nanostructured coating possesses all the key traits of a clinically promising candidate to address the myriad of challenges associated with bone regeneration.
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Affiliation(s)
- Helin Xing
- Department of Prosthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Xing Wang
- Hospital of Stomatology, Shanxi Medical University, Taiyuan, 030001, China
| | - Gao Xiao
- School of Biomass Science and Engineering, Sichuan University, Chengdu, 610065, China; Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02115, United States
| | - Zongmin Zhao
- Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02115, United States
| | - Shiquan Zou
- Department of Prosthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Man Li
- Department of Prosthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Joseph J Richardson
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology and Department of Chemical and Biomolecular Engineering, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Blaise L Tardy
- Department of Bioproducts and Biosystems, School of Chemical Engineering, Aalto University, P. O. Box 16300, 00076, Finland
| | - Liangxia Xie
- Department of Pathology, Brigham and Women's Hospital, Harvard University, Boston, MA, 02115, United States
| | - Satoshi Komasa
- Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Hirakata, Osaka, 540-8570, Japan
| | - Joji Okazaki
- Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Hirakata, Osaka, 540-8570, Japan
| | - Qingsong Jiang
- Department of Prosthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, 100050, China.
| | - Guodong Yang
- The State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, School of Basic Medicine, The Fourth Military Medical University, Xi'an, 710032, China.
| | - Junling Guo
- School of Biomass Science and Engineering, Sichuan University, Chengdu, 610065, China; Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02115, United States.
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44
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Wang X, Wang H, Zhang T, Cai L, Kong C, He J. Current Knowledge Regarding the Interaction Between Oral Bone Metabolic Disorders and Diabetes Mellitus. Front Endocrinol (Lausanne) 2020; 11:536. [PMID: 32903738 PMCID: PMC7438828 DOI: 10.3389/fendo.2020.00536] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus, a major chronic disease affecting human health, has been increasing in prevalence in recent years. Diabetes mellitus can cause bone metabolic disorders in patients, leading to osteoporosis, a higher risk of traumatic fracture, and other bone diseases. Bone metabolic disorders in the oral cavity principally manifest as periodontitis, loss of alveolar bone, and failure of implant osseointegration. In recent years, numerous studies have shown that there is a complex interaction between bone metabolic disorders and diabetes mellitus. This paper reviews the adverse effects of diabetes on oral bone metabolism disorders such as alveolar osteoporosis and bone loss in patients with periodontitis, discusses the potential mechanisms of diabetic bone loss, and suggests potential ways to prevent and treat oral bone loss in patients with diabetes mellitus.
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Affiliation(s)
- Xiaofeng Wang
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Pediatrics, Pediatric Research Institute, The University of Louisville School of Medicine, Louisville, KY, United States
| | - Huiyu Wang
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tianfu Zhang
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lu Cai
- Department of Pediatrics, Pediatric Research Institute, The University of Louisville School of Medicine, Louisville, KY, United States
- Departments of Radiation Oncology, Pharmacology, and Toxicology, University of Louisville, Louisville, KY, United States
| | - Chenfei Kong
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Chenfei Kong
| | - Jinting He
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
- Jinting He
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45
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Saito H, Aichelmann‐Reidy MB, Oates TW. Advances in implant therapy in North America: Improved outcomes and application in the compromised dentition. Periodontol 2000 2019; 82:225-237. [DOI: 10.1111/prd.12319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hanae Saito
- Division of Periodontics Department of Advanced Oral Sciences & Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
| | - Mary Beth Aichelmann‐Reidy
- Division of Periodontics Department of Advanced Oral Sciences & Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
| | - Thomas W. Oates
- Department of Advanced Oral Sciences & Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
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46
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Abstract
It has been estimated that by 2030, the number of patients with diabetes aged > 64 years will be > 82 million in underdeveloped countries, and > 48 million in developed countries. Chronic hyperglycemia delays wound healing by reducing the expression of growth factors in the wound fluid and re-epithelialization. Impaired wound healing in patients with diabetes has also been associated with inhibition of the production of stromal cell-derived factor-1alpha by several tissues including bone marrow, brain, heart, spleen, and gingivae. Chronic hyperglycemia interferes with the osseointegration of implants by deferring the expression of fibronectin and integrins. Results from experimental studies have shown a significantly higher bone-to-implant contact around implants placed in healthy animals compared with animals with streptozotocin-induced diabetes. Moreover, persistent hyperglycemia plays a role in abnormal differentiation of osteoclasts, thereby making bone tissue more susceptible to resorption. Furthermore, persistent hyperglycemia has also been associated with increased peri-implant soft tissue inflammation (increased peri-implant bleeding on probing and probing depth) and crestal bone loss. Clinical studies have shown that under optimal glycemic control dental implants can show success and survival rates of up to 100% in patients diagnosed with diabetes. Although patients with diabetes can undergo dental implant therapy and can exhibit implant survival similar to those in systemically healthy individuals, the contribution of glycemic control and regular oral hygiene maintenance cannot be disregarded.
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Affiliation(s)
- Fawad Javed
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York.,Department of Oral Surgery and Implant Dentistry, Dental School, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York.,Department of Oral Surgery and Implant Dentistry, Dental School, Johann Wolfgang Goethe University, Frankfurt, Germany
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47
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de Oliveira-Neto OB, Santos IO, Barbosa FT, de Sousa-Rodrigues CF, de Lima FJC. Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews. Med Oral Patol Oral Cir Bucal 2019; 24:e483-e490. [PMID: 31232387 PMCID: PMC6667003 DOI: 10.4317/medoral.22955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. Material and Methods An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. Results We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. Conclusions Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies. Key words:Dental implants, diabetes, systematic review, meta-analysis, survival rate.
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Affiliation(s)
- O-B de Oliveira-Neto
- Department of Morphology, Anatomy Area, Piracicaba School of Dentistry, University of Campinas, Av. Limeira, 901-Areião, Piracicaba, São Paulo, Brazil,
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48
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Doornewaard R, Glibert M, Matthys C, Vervaeke S, Bronkhorst E, de Bruyn H. Improvement of Quality of Life with Implant-Supported Mandibular Overdentures and the Effect of Implant Type and Surgical Procedure on Bone and Soft Tissue Stability: A Three-Year Prospective Split-Mouth Trial. J Clin Med 2019; 8:E773. [PMID: 31159202 PMCID: PMC6617188 DOI: 10.3390/jcm8060773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022] Open
Abstract
In fully edentulous patients, the support of a lower dental prosthesis by two implants could improve the chewing ability, retention, and stability of the prosthesis. Despite high success rates of dental implants, complications, such as peri-implantitis, do occur. The latter is a consequence of crestal bone loss and might be related to the implant surface and peri-implant soft tissue thickness. The aim of this paper is to describe the effect of implant surface roughness and soft tissue thickness on crestal bone remodeling, peri-implant health, and patient-centered outcomes. The mandibular overdenture supported by two implants is used as a split-mouth model to scrutinize these aims. The first study compared implants placed equicrestal to implants placed biologically (i.e., dependent on site-specific soft tissue thickness). The second clinical trial compared implants with a minimally to a moderately rough implant neck. Both studies reported an improvement in oral health-related quality of life and a stable peri-implant health after three years follow-up. Only equicrestal implant placement yielded significantly higher implant surface exposure, due to the establishment of the biologic width. Within the limitations of this study, it can be concluded that an implant supported mandibular overdenture significantly improves the quality of life, with limited biologic complications and high survival rates of the implants.
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Affiliation(s)
- Ron Doornewaard
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Maarten Glibert
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Carine Matthys
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Stijn Vervaeke
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Ewald Bronkhorst
- Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
| | - Hugo de Bruyn
- Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
- Section Implantology & Periodontology, Department of Dentistry, Radboudumc, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
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49
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Souto-Maior JR, Pellizzer EP, de Luna Gomes JM, Dds CAAL, Dds JFSJ, Vasconcelos BCDE, de Moraes SLD. Influence of Diabetes on the Survival Rate and Marginal Bone Loss of Dental Implants: An Overview of Systematic Reviews. J ORAL IMPLANTOL 2019; 45:334-340. [PMID: 31042455 DOI: 10.1563/aaid-joi-d-19-00087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to conduct an analysis of the systematic reviews (SRs) in literature about the implant survival rate (ISR) and marginal bone loss (MBL) in diabetic and nondiabetic patients. This work was registered in The International Prospective Register of Systematic Reviews (CRD42018095314) and was developed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Library Handbook. A search was performed on PubMed, Cochrane, Scopus, Embase, and LILACS. The PICO (problem/patient/population, intervention/indicator, comparison, outcome) question was "Do the survival rates of dental implants and marginal bone loss differ between diabetic and nondiabetic patients?" A total of 130 articles were retrieved. After eliminating repetitions, 118 were reviewed. Finally, 6 SRs were included. All the reviews indicated that there is no effect of diabetes on the ISR; however, a negative effect of the disease can be observed in MBL. Analysis of the quality of the studies was performed using the assessment of SRs in dentistry (Glenny Scale) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2). Glenny Scale showed a moderate to high quality of the included studies. In contrast, AMSTAR 2 pointed out a critically low level for 4 studies, with no study fulfilling the criteria for high quality. It may be concluded that there is no effect of diabetes on the ISR; however, a negative effect of the disease can be observed on MBL.
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Affiliation(s)
- Juliana Raposo Souto-Maior
- Department of Prosthodontics, Faculty of Dentistry, Pernambuco University (UPE), Camaragibe, Pernambuco, Brazil
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Sao Paulo, Brazil
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50
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Abstract
There are few absolute contraindications to dental implant placement. Relative contraindications include cognitive decline, American Society of Anesthesiology patient status IV or higher categories, or medical conditions that may jeopardize the life or lifespan of the patient. Precautions for placing dental implants should be viewed with respect to the evidence-based exposures that can contribute to risk of failure, including but not limited to local, behavioral, and medical factors. Risk for dental implant failure increases in association with (1) past history of periodontal disease, (2) bruxism, (3) smoking, and (4) radiation therapy.
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Affiliation(s)
- Amritpal S Kullar
- Division of Oral Diagnosis, Oral Medicine, Oral Radiology, MN324 College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40356-0297, USA
| | - Craig S Miller
- Division of Oral Diagnosis, Oral Medicine, Oral Radiology, MN324 College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40356-0297, USA.
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