Diabetes mellitus (hereafter referred to as diabetes) is a group of metabolic disorders which cause hyperglycaemia. It has been linked to several co-morbidities however for oral health, periodontitis is a particular concern. In fact, the periodontitis and diabetes both have a bidirectional relationship where diabetes is associated with an increased severity and prevalence of periodontitis and severe periodontitis associate with compromised glycaemic control (Casanova et al 2014). With an increase in the number of dental implants being placed in the last ten years, it is of interest to determine if patients with diabetes have greater dental implants complications.
The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to inform the methodology of this systematic review and meta-analysis. Studies which included both diabetes and healthy controls with dental implant placement in the form of randomised control trials or retrospective cohort/prospective cohort studies were included. Quality assessment of included studies was conducted through the Newcastle-Ottawa Scale.
- 10 studies were included in this systematic review comprising 8 prospective cohort studies and 2 retrospective cohort studies.
- In total, there were 625 participants (360 with diabetes and 265 that were healthy).
- The implant marginal bone loss was significantly higher in patients with diabetes than without (0.15 (95% CI=0.10, 0.20; p<0.00001)). There was low heterogeneity between studies (p=0.47, I2=0%).
- The probing depth was significantly higher in patients with diabetes than without (MD: 0.30; 95% CI 0.08, 0.51; p = .007) however the heterogeneity between the studies was high.
- Bleeding on probing was significantly better in the healthy control group than in the diabetes group (MD: 22.62; 95% CI 16.82, 28.43; p < .00001) however heterogeneity between studies was high.
- Egger’s regression test determined that there was no significant publication bias in the studies marginal bone loss (p = .146) or bleeding on probing (p = .558); however, there was possible publication bias in the studies of probing depth (p = .002).
The authors concluded:
…despite the limitations of this review, implants are feasible for patients with diabetes. There is evidence, however, that these patients are more likely to have clinical complications than patients without diabetes.
The control of diabetes is measured using HbA1c however the authors reported that only 3 of the 10 articles used this as a measure. Different diabetes indicators will not allow an accurate comparison of the severity of diabetes and its management which will affect the interpretation of the results. The author’s results support the Cochrane systematic review which showed the risk of implant loss and risk of peri-implantitis was higher in patients that were periodontally compromised (Dental Elf – 16th Jan 2014) however larger randomised studies need to be undertaken to understand this relationship with respect to diabetes and glycaemic control.
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 Jan;79(1):9-18. doi: 10.1080/00016357.2020.1761031. Epub 2020 May 13. PMID: 32401121.
Casanova L, Hughes FJ, Preshaw PM. Diabetes and periodontal disease: a two-way relationship. Br Dent J. 2014 Oct;217(8):433-7. doi: 10.1038/sj.bdj.2014.907. PMID: 25342350.
Dental Elf – 16th January 2014