Table 1 List of the included studies and its main characteristics
From: Dental implants and diabetes mellitus—a systematic review
Author | Year | Study type | Diabetes type | Control | Diabetes therapy | Glycemic control [HbA1c %] | Duration of diabetes (years) | Number of patients | Number of implants | Duration of study (years) | Implant survival [%] | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Alsaadi | 2007 | Retrospective | Type II | Non-diabetes | n.d. | n.d. | n.d. | 2004 (overall) | 6946 (overall) | 6 months | 96.4 (global) | Diabetes does not cause higher failure rate in the first 6 months. |
Aguilar-Salvatierra | 2015 | Prospective | Type II | 3 groups (HbA1c) | n.d. | 6–8 (well), 8–10 (moderately), >10 (poorly) | n.d. | 85 | 85 | 2 | 100 vs. 96.6 vs. 86.3 | Patients with diabetes can receive implant-based treatments, providing they present moderate HbA1c values. Peri-implantitis increases with elevated HbA1c. |
Anner | 2010 | Retrospective | n.d. | Non-diabetes | n.d. | n.d. | n.d. | 49 diabetes, 475 overall | 1626 | 3 ± 2 | 97.2 vs. 95 | Diabetes was not related to implant survival in this patient cohort. |
Busenlechner | 2014 | Retrospective | n.d. | Non-diabetes | n.d. | n.d. | n.d. | 4316 | >10,000 | 8 years | 95.1 vs. 97 | Diabetes does not have any influence on implant survival after 8 years, if blood sugar is effectively controlled. |
Daubert | 2015 | Cross-sectional | n.d. | Non-diabetes | n.d. | n.d. | n.d. | 8 diabetes, 96 overall | 225 | 10 | n.d. | Significant associations between implant failure and diabetes (relative risk 4.8 and 3.3) and peri-implant diseases and diabetes (relative risk 4.1). |
Dowell | 2007 | Prospective | Type II | Non-diabetes | Diet, oral, insulin and combination | 6–8 (well), 8–10 (moderately), >10 (poorly) | n.d. | 25 diabetes, 10 non-diabetes | 38 diabetes, 12 non-diabetes | 4 months | 100 | Diabetes has no negative influence; the quality of glycemic control has no effect on implant success. |
Erdogan | 2014 | Prospective | Type II | Non-diabetes | n.d. | Mean 6.8 | 7.5 | 12 diabetes, 12 control | 43 | 1 | 100 | No significant difference for wound healing, radiographic findings, implant success and volume of augmentation (guided bone regeneration with bone scrapes and bone substitute material). |
Ferreira | 2006 | Cross-sectional | n.d. | Non-diabetes | n.d. | Blood sugar >126 mg/dl or diabetic medication subscribed | n.d. | 212 (overall) | 578 (overall) | 6 months–5 years | n.d. | Risk for peri-implantitis in “uncontrolled” diabetes is 1.9 times higher compared to the non-diabetes group. |
Fiorellini | 2000 | Retrospective | Types I and II | None | n.d. | “Proper levels of glycemic control” | 8.9 ± 14.3 | 40 | 215 | 6.5 | 85.6 | Survival rate is lower than for general population, but there is still a reasonable success rate. Most implant failures are in the first year after loading. |
Ghiraldini | 2015 | Prospective | Type II | Non-diabetes | n.d. | <8 (better) >8 (poorly) | 10.7 ± 5 | 16 better, 16 poorly, 19 control | 51 | 1 | 100 | Poor glycemic control negatively modulated the bone factors during healing, although diabetes (regardless of glycemic control) had no effect on implant stabilization. |
Gomez-Moreno | 2014 | Prospective | Type II | 4 groups (HbA1c) | n.d. | <6 (healthy), 6–8 (well), 8–10 (moderately) >10 (poorly) | n.d. | 67 | 67 | 3 | n.d. | Elevated HbA1c causes more bone loss (not significant) and significantly higher BOP. Probing depth is not influenced by glycemic control. |
Khandelwal | 2011 | Prospective | Type II | 2 different types of implants | n.d. | 7.5–11.4 (poorly controlled) | n.d. | 24 | 48 | 4 months | 98 | Successful implant therapy in patients suffering poorly controlled diabetes. No difference between the two implant systems. |
Morris | 2005 | Prospective | Type II | Non-diabetes | n.d. | n.d. | n.d. | 663 | 255 diabetes, 2632 non-diabetes | 3 | 92.2 and 93.2, respectively | Diabetic patients tend to have more failures than non-diabetic patients. The use of CHX resulted in a slight improvement in survival in non-diabetic patients and in a greater improvement in type II patients, the same effect for antibiotic use. |
Moy | 2005 | Retrospective | n.d. | Non-diabetes | n.d. | n.d. | n.d. | 48 diabetes, 1140 overall | 4684 (overall) | up to 20 | n.d. | Significantly increased relative risk for implant failure (relative risk = 2.75). |
Oates | 2009 | Prospective | Type II | Non-diabetes | Diet, oral, insulin and combination | 6–8 (well), 8–10 (moderately), >10 (poorly) | n.d. | 32 | 42 | 4 months | Patients with poorly controlled HbA1c have lower stability in the first 2–6 weeks, but it reaches the baseline in the following weeks. But reaching the baseline takes two times the duration it needs in the non-diabetic group. | |
Oates | 2014 | Prospective | Type II | Non-diabetes | n.d. | 6–8 (well), >8 (poorly) | n.d. | 44 well, 19 poorly, 49 control | 220 | 1 | 99 | The initial implant stability is lower in diabetic patient, but 1 year after insertion there in so difference even in the poorly controlled group. Diabetes has no influence on implant survival. |
Olson | 2000 | Prospective, multicenter | Type II | None | Diet, oral, insulin and combination | n.d. | n.d. | 89 | 178 | 5 | 91 vs. 88 | Implants in mandibular symphysis in diabetic patient are a predictable procedure. Duration of diabetes may be associated with implant failure, CHX improves implant survival. |
Peled | 2003 | Retrospective | Type II | None | n.d. | “Well-controlled,” no data for HbA1c | n.d. | 41 | 141 | 1 and 5 | 97.3 vs. 94.4 | No correlation was found between failed implants and glucose level. The clinical outcome of dental implants in a selected group of patients with well-controlled type II diabetes mellitus is satisfying and encouraging. |
Tawil | 2008 | Prospective | Type II | Non-diabetes | n.d. | <7 (well), 7–9 (moderately), >9 (poorly) mean 7.2 | n.d. | 54 diabetes, 54 control | 255 diabetes, 244 control | 1 to 12 | 97.2 vs. 98.8 | No significant difference for implant survival between the groups and no difference between good and medium glycemic control for bone resorption. Augmentations caused no complications. Duration of diabetes was no confounder. |
Tatarakis | 2013 | Prospective | Type II | None | n.d. | Mean 7.1 | n.d. | 32 | >32 | 1 | n.d. | The clinical, microbiological, salivary biomarkers and psychosocial profiles of patient with diabetes under good control are very similar to those of non-diabetes. |
Turkyilmaz | 2010 | Retrospective | Type II | None | Diet, oral, insulin and combination | 5–10 | 5–21 | 10 | 23 | 1 | 100 | No evidence of diminished clinical success, BOP negative, no pathological probing depth, marginal bone loss 0.3 ± 0.2 mm. |
Zupnik | 2011 | Retrospective | n.d. | Non-diabetes | n.d. | n.d. | n.d. | n.d. | 25 diabetes, 316 non-diabetes | 4 | 96.4 (global) | Implant failure (explantation) is 2.57 times higher for patient with diabetes than patients without diabetes after 4 years. |