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A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Peri-implant evaluation in type 2 diabetes mellitus patients

Implant therapies for patients with diabetes are predictable if patients fall within controlled glycemic ranges over time, as assessed by monitoring glycated hemoglobin (HbA1c) levels. The finding is from a study published in the September 2015 issue of Clinical Oral Implants Research.

The study’s authors set out to measure changes in peri-implant tissues in patients with type 2 diabetes mellitus who had different glycemic levels. They monitored HbA1c levels over a 3-year period after placement of dental implants.

Researchers divided 67 patients into 4 groups according to HbA1c level: 21 patients in Group 1 (< 6, control), 24 patients in Group 2 (6.1-8), 11 patients in both Group 3 (8.1-10), and Group 4 (> 10.1). Each patient received 1 implant. All implants were placed in the anterior zone of the maxilla. Measured variables included probing depth, bleeding on probing, and marginal bone loss.

The implant bed was prepared following the manufacturer’s instruction for the placement of Straumann bone level implant (10-14 millimeters long and 3.3-4.1 mm in diameter). All implants were placed following a submerged protocol and topped with a closure screw to avoid loading during the healing process. After implant insertion, radiographs were obtained at the moment of prosthetic placement following standardized parameters to compare crestal bone levels later in the study.

Marginal bone loss was found to increase in relation to increases in HbA1c levels. Control group levels varied from 0.41 mm at 1 year to 0.53 mm at 3 years. In Group 4, crestal bone loss values increased from 0.54 mm at 1 year to 0.70 mm at 3 years. Only bleeding on probing showed statistically significant differences among groups. When the peri-implant area was probed, mean levels of bleeding varied at 1 year from 0.43 in Group 1 to 0.62 in Group 4. At 2 years, greater bleeding on probing was observed in Group 4 than in groups with lower HbA1c levels, a relationship that was repeated at 3 years. Peri-implant pocket depths had values that were too low to be considered pathologic, and there were no statistically significant differences between the study groups. At 1 year, mean probing depth ranged from 2.19 mm in Group 1 to 2.33 mm in Group 4; these values rose only slightly during the subsequent study periods.

Crestal bone resorption showed a proportional relationship to glycemic levels, whereby greater marginal bone loss was seen in Group 4 compared with Group 1, which showed physiological HbA1c levels.

“The study provides a new overview of peri-implant tissue responses among diabetic patients, which permits an assessment of an important risk factor for dental implant failure,” the authors concluded. “For this reason, control and treatment of periodontal infections should be a key element in the overall care of patients with diabetes mellitus and could play an important role in ensuring the success of implant therapy.”

Read the original article.

 

Consulting Editor: Clark M. Stanford, DDS, PhD
Distinguished Professor and Dean
University of Illinois at Chicago College of Dentistry
Treasurer, Academy of Osseointegration Board of Directors


Proinflammatory cytokines in the crevicular fluid near dental implants in patients with type 2 diabetes

Dental implant therapy can be offered to patients with well-controlled type 2 diabetes mellitus (T2DM). No significant difference exists between patients without diabetes and those with diabetes in terms of clinical parameters or levels of gingival crevicular fluid (GCF) and peri-implant gingival crevicular fluid (PICF). Those findings are from a study published in the September/October 2015 issue of The International Journal of Oral and Maxillofacial Implants.

The authors designed the study to compare PICF and GCF levels of interleukin-1b (IL-1b) and tumor necrosis factor (TNF) among natural teeth sites with implant sites in patients with well-controlled type 2 diabetes.

The study featured 20 participants who were missing 1 or more teeth who potentially could benefit from dental implant therapy. A total of 13 patients (Group D) had well-controlled T2DM and 7 patients (Group C) were systematically healthy. Researchers took clinical measurements and collected samples of CGF and PICF from the sulci of both adjacent teeth and implants at baseline, 1 month, 4 months, and 7 months.

Researchers placed 39 implants: 27 in group D and 12 in group C. They used a single-stage surgical protocol for implant placement. Implants were provided with definitive superstructures 4 months after placement. Researchers analyzed concentrations of IL-1b and TNF-X by using enzyme-linked immunosorbent assay kits that were available commercially.

Mean glycated hemoglobin (HbA1c), FGC and PIGC levels in Group D were statistically significantly higher than those in Group C at baseline. No significant differences were found between the 2 groups in terms of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG) levels. HbA1c levels were statistically significantly higher in Group D after implant placement at 7 months compared with baseline levels. No significant changes were observed in the other parameters during the study period in Group D.

Implant stability quotient levels at 4 months were significantly higher than at baseline. Alveolar bone implant levels were statistically lower at 4 and 7 months compared with baseline; they were statistically lower at 7 months than at 4 months in Group D. Researchers found no significant differences between groups regarding bone levels around implants and no significant differences in IL-1b and TNF-X levels for either the teeth or implants or between the 2 groups.

Researchers noted several limitations of the study, including a small sample size and the fact that patients were followed for only 3 months after prosthesis placement and 7 months after implant placement.

“This is the first study designed to prospectively evaluate the effect of T2DM on clinical conditions at both implants and teeth,” the authors concluded, “as well as on alveolar bone loss around implants, implant stability and the levels of proinflammatory cytokines in PICF and GCF.”

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How elevated glycated hemoglobin levels in patients with type 2 diabetes affect dental implants

Elevated glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes are not associated with altered implant survival 1 year after loading, but changes in early bone healing and implant stability are associated with hyperglycemia. The findings were published in the December 2014 issue of The Journal of the American Dental Association

Researchers designed a study to measure the effects of elevated glycemic levels on implant survival and stability over 16 months, including 1 year after implant restoration.

The patient sample consisted of 117 edentulous patients. Each received 2 mandibular implants for a total of 234 implants. Implant-retained mandibular overdentures were loaded after a 4-month healing period and followed up for 1 year. The authors assessed the implants’ survival and stability (using resonance frequency analysis) relative to HbA1c levels, with levels at baseline up to 11.1% and levels at 1 year as high as 13.3%.

Patients received 2 transmucosal implants in the anterior mandible to support a mandibular overdenture. The surgeons determined implant length on the basis of existing bone dimensions and, in appropriate cases, they placed implants of the same length in both sites. Next, they placed transmucosal healing caps and made denture base adjustments to eliminate any contact between the implant and denture.

Researchers assessed implants over a 4-month healing period after placement and at 3, 6, and 12 months after implant restoration. Examiners obtained blood samples at the time of implant placement (baseline), at 2 months, at 4 months (implant loading), and at 3, 6, and 12 months after loading. Patients with HbA1c levels of 8.1% or greater were classified as having poorly controlled diabetes.

Baseline HbA1c values ranged from 5.1% to 11.1%. The highest HbA1c value was 13.3% at 2 months after surgery, 12.1% at implant loading, 11.9% at 3 months after loading, 12.0% at 6 months after loading, and 12,6% at 12 months after loading. At the time of implant placement, 50 patients (42.7% of the 117 participants) did not have diabetes (HbA1c level, ≤ 5.9%), 47 (40.2%) were in the well-controlled diabetes group (HbA1c level, 6.0-8.0%), and 20 (17.1%) were in the poorly controlled diabetes group (HbA1c level, ≥ 8.1%).

Implant survival rates for 110 of the 117 patients who were followed up for 12 months after loading were 99.0%, 98.9%, and 100%, respectively, for patients who did not have diabetes (n = 47), those with well-controlled diabetes (n = 44), and those with poorly controlled diabetes (n = 19). Two implants failed at 4 weeks, 1 in the nondiabetes group and the other in the well-controlled diabetes group. Delays in implant stabilization were related directly to poor glycemic control.

Researchers used a delayed healing period (4 months before restoration) to allow for adequate implant integration, and the restorative treatment was limited to the use of mandibular implant-supported overdentures for edentulous patients.

Read the original article.

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Academy of Osseointegration announces call for abstracts, new student travel grants

Known as the multi-disciplinary nexus where specialists and generalists from around the globe can come together to evaluate emerging research and share best information in implant dentistry, the Academy of Osseointegration is now accepting abstracts for its 2018 Annual Meeting to be held February 28-March 3 in Los Angeles.

Researchers and student researchers are invited to submit abstracts for Clinical Innovations, Oral Research (Scientific and Clinical), and Electronic Poster (Scientific, Clinical, and Case Studies) presentations before 11:59 p.m. EST on September 29, 2017 via https://osseo2018.abstractcentral.com.

Also, the Osseointegration Foundation will award 20 $1,000 student travel grants to students currently enrolled in a dental school program who submit the top scoring oral research and e-poster abstracts. Only authors indicating their interest via the abstract submission site (https://osseo.org/student-travel-grant-program/) will be considered for these grants.

AO’s 2017 Annual Meeting saw nearly 260 abstracts submitted and more than 200 e-posters on display. An elite group of researchers received honors for their outstanding contributions to the field of implant dentistry during the annual business meeting, which more than 2,000 dental colleagues attend each year. Will you be one of them? Submit your abstract today!

 
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JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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