Introduction:
Various research studies and analysis reports in dentistry and current dental implantology have indicated that diabetic patients may pose a notable risk of dental implant failure and are more susceptible to increased marginal bone loss around the dental implants when compared to non-diabetic patients. This would account for the greater rate of dental implant failure in diabetic patients with poor glycemic control when compared to non-diabetic patients or diabetic patients with very good or good glycemic control. Many dental researchers have further rejected the theories that poor glycemic control can lead to issues in the osseointegration of dental implants. Instead, in individuals with poor glycemic control or response, instead of osseointegration (the normal or healthy bone dental implant fusion), the connective tissues would interfere leading to a phenomenon called fibro osseous integration that eventually leads to loss of primary stability of the dental implant, leading up to dental implant failure.
These research-based results that have been studied in diabetic cases are mainly attributed to the deleterious effects of diabetes mellitus on the organ systems. This is due to the altered immunity and the alterations in the normal physiological processes occurring in the human body in these individuals.
Dental Implant failure could be initiated early in contraindicated cases such as diabetes type 1 or type 2 with generally poor glycemic control as the host's ability to establish or promote osseointegration, especially in the early stages of healing would lead to undesirable sequelae. This sequel can result either in fibro-osseous integration in delayed wound healing or increased marginal bone loss around the dental implants, leading to the possibility of dental implant failure in the long term. Further, it should be noted that dental research shows that when the glycemic control itself is poor in diabetic patients, then even despite initiating dental or periodontal (gum) therapies to improve the soft tissue and hard tissue healing in these individuals, dental implant failure can still be a clear possibility. This is because there has been little scientific evidence that is yet to prove that periodontal therapy can improve the glycemic control of patients.
What Are the Reasons for Dental Implant Failure in Diabetic Patients?
One of the most common and negative effects of diabetes mellitus on the body that has been noted in medical research is impaired bone metabolism and poor bone strength or lowered density in patients. This is because the phenomenon of hyperglycemia (increased blood glucose level) associated with diabetes mellitus (due to poor glycemic control) would progressively worsen or reduce the bone mineral density (BMD) in individuals making them highly prone to an increased risk of fractures (pathologic bone fractures). In aging individuals further, it is not uncommon to notice that a continuous or poorly controlled glycemic state can increase urinary calcium excretion, causing the accumulation of advanced glycation products. These accumulated detrimental compounds in diabetic patients would result eventually in a pro-inflammatory state, with current medical research highlighting that there is a lesser chance for healthy osseointegration or bone implant fusion. Current medical research shows that a lower level of insulin-like growth factor 1 (IGF-1), and lower pH (potential of hydrogen) or acidosis (build-up of acid in the bloodstream) in older individuals suffering from type 1 or type 2 diabetes and with poor glycemic control in spite of being on medications, directly experience a delayed wound as well as bone healing. These cases are hence contraindicated in the field of implant dentistry unless the criterion for placement of dental implants is fulfilled by the patient through effective or good glycemic control. Apart from this, in diabetic patients, the function of the immune cells is altered. As a result, the suitability of the body to various infections is increased. Also, the defense mechanism of the body is weakened.
The process of placing a dental implant in the jaw involves a carefully controlled surgical procedure that involves impacting the bone tissues or jaw of the patient. Following the placement of the dental implant, the healing process around the implant, known as osseointegration, begins only when a specific sequence of events occurs in individuals with proper glycemic control and healing response.
The initial stage of healing involves the formation of a blood clot, followed by vascularization, and then the proliferation and migration of mesenchymal stem cells (MSCs). These cells then differentiate into osteoblasts, which are bone-forming cells that integrate with the dental implants in the jaw. Subsequently, a woven bone is formed through osteogenesis, which is then compacted and remodeled.
However, this process of healthy osseointegration can be disrupted in individuals with poor glycemic control, as seen in current research on dental implants and diabetes. Impaired bone cell metabolism in these patients prevents healthy bone from interacting or fusing with the dental implants. Also, poor infection control increases the susceptibility to infection of the tissues around the implant after placement. Such complications can even be seen after successful osseointegration.
How Are Diabetic Patients Eligibility for Dental Implants Determined?
According to dental implantologists and diabetic specialists, individuals with diabetes who are able to maintain an HbA1c level of 6.5 percent or below are considered to be in good glycemic control. These patients fall under the category of controlled diabetes mellitus and may be suitable candidates for dental implants. However, before proceeding with the implant procedure, the dentist or dental implantologist should conduct a comprehensive assessment of the patient's bone density and evaluate both local and systemic risk factors.
Conclusion:
Because of the altered immunity and the pro-inflammatory state that has been described above both in patients suffering from type 1 and type 2 diabetes, it should be noted that the compromised bone matrix of the individuals may hinder the proper healing of bones, leading to potential issues with dental implant stability over time and an increased risk of inflammation in the surrounding soft tissues. Recent dental research indicates that the extent of marginal bone loss in individuals with dental implants directly correlates with the long-term primary stability of the implant, thereby influencing its overall health. A comprehensive analysis of various research studies reveals a significant increase in marginal bone loss among diabetic patients, which can ultimately lead to failure of the implant even after its placement.
