Dental Implant Considerations for Diabetics

Are Dental Implants Contraindicated in Diabetic Patients?

Diabetes mellitus is the condition or group of metabolic diseases that result in a patient being characterized by a continuing state of hyperglycemia (higher levels of glucose in the bloodstream). This state of hyperglycemia would be either because of defects in insulin secretion, that is when the pancreas does not produce enough insulin or the insulin action itself is ineffective. The most common type of diabetes mellitus is type 2 diabetes, which is a lifestyle or obesity-initiated disease and accounts for up to 90 to 95 percent of all the individuals who are suffering from diabetes mellitus with a nearly estimated 537 million adults affected as of 2021, with a future prediction of around roughly 643 million adults who would be affected by diabetes by 2030.

The high global statistics and prevalence rates further highlight the importance of individuals suffering from long-term hyperglycemia who can be prone to multiple systemic or organ-related complications. However, Individuals who are in good glycemic control, with an HbA1c (hemoglobin A1c) level of 6.5 or below can be deemed suitable dental implant cases, given that their systemic status and local risk factors are in check.

In the cases of poor glycemic control higher than an HbA1c of 7, long-term research studies have indicated that they would be prone to dental implant failures or the survival rates of dental implants can be certainly impacted because of the altered micro physiology, altered bone healing, and altered wound healing as well in diabetic cases. This article will explore the criteria considered by dental implantologists for determining eligibility for dental implantation.

What Are the Key Dental Implant Considerations for Diabetics?

Patients with good glycemic control can certainly be managed just as other healthy subjects or normal patients according to current dental implant research. It is recommended that the elective treatment for dental implants can be delayed when the fasting blood glucose level is either less than 70 mg/dL or more than 200 mg/dL or when the HbA1c level is more than 7 percent. This recommendation given by diabetologists for dental practice or professionals is based on the research-based evidence that patients with a blood glucose level of less than 70 mg/dL are the supposedly high-risk candidates for developing hypoglycemic events, while those patients who would have a blood glucose level higher than 200 mg/dL or an HbA1c level over 7 percent are subjects categorized under poor glycemic control, most likely to suffer the complications associated with microvascular or macrovascular disease patterns that are commonly observed in them.

According to the current or acceptable criterion for performing dental implantation, a good glycemic control: HbA1c less than 6.5 percent is the accepted baseline, and the pre-prandial glycemia of the diabetes mellitus patient in mg/dL: should be between 80 to 110 with the maximum postprandial level of glycemia being less than 180.

How Should Diabetic Patients Be Evaluated Preoperatively?

Pre-operative evaluation through radiographic imaging such as CBCT (cone-beam computed tomography) or OPG (orthopantomogram) is needed to evaluate the patient's bone density and the exact location of the dental implant, to ensure that it will not contact any vital nerve or blood structures in the upper or lower jaw. Currently, dental surgeons recommend CBCT to be the radiographic modality of choice before dental implantation, so that the pre-operative evaluation of the patient's bone density can be clearly visualized. Preoperative antibiotic therapies along with strict oral hygiene control, mechanical and chemical plaque control measures, and the use of 0.12 percent Chlorhexidine mouthwash as a standard measure can be instructed by the dental surgeon before dental implantation.

What Are the Factors That Promote Osseointegration in Diabetic Cases?

The factors that should be taken to facilitate better osseointegration (bone-implant fusion) and to prevent any possible risks of dental implant failure are as follows:

• The dental implantologist or implant specialist should opt for a screw-shaped design, ensure the surface roughness of the implant, and ensure that the surface purity of the implant is intact, which are the major implant-related local factors that would help achieve a better osseointegration or bone dental implant fusion or contact in the diabetic patient.

• Currently dental implant research shows that hydroxyapatite plasma-spray-coated implants are known to possess a higher survival rate than titanium implants in type 2 diabetic patients, almost in a comparative 97.9 versus 84.7 percent survival rates in these cases respectively, noted after 36 months of dental implantation. This shows that the hydroxyapatite (HA) plasma-spray-coated implants would not be as susceptible to dental implant failure through any sort of microbial contamination, dissolution, etc. Hence the risk of implant mobility or risk fracture of the HA implants compared to titanium surface implants would also possibly be a consideration factor to the dental implantologist before implantation in the diabetic cases.

• Diabetic patients should not be prone to prosthetic complications, to avoid implant failure. Hence, the most important principle to achieve the primary or initial stability of the dental implant is to gain full coverage of the fixtures that should be ideally placed in the patient with good glycemic control possessing a vascularized, osteogenic bone. Care should be taken to distribute the forces of mastication or chewing evenly in diabetic patients in terms of the prosthetic load or load-bearing forces, with the design of the fixture well adapted to the patient.

• Care should be taken by the implantologist to avoid contact with vital points such as the anterior loop of the mandibular canal or the nasopalatine duct to prevent any interference either with nerve functions or with the phenomenon of healthy osseointegration. The available bone volume in the diabetic patient's jaw should be assessed thoroughly by the dentist in different areas preoperatively by the palpation method and then radiographic imaging would be the main insight or lead into the dental implant surgical planning for the patient.

• Postoperatively, the dental implantologist should initiate regular follow-ups or periodic prophylaxis and check-ups with the diabetic patients to ensure that the primary stability of the implants is good, by both clinical and radiographic assessment.

Conclusion

Dental implant placement in diabetic patients requires careful consideration due to the potential impact of diabetes on wound healing and implant success. To conclude, If proper measures are taken into consideration, through preoperative and post-operative planning as well, diabetic patients with good glycemic control can be suitable cases for dental implants.