Javed Fawad, Romanos George E
Division of Research, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.
J Periodontol. 2009 Nov;80(11):1719-30. doi: 10.1902/jop.2009.090283.
Implant treatment is an attractive substitute to traditional fixed/removable prosthetic appliances. In patients with diabetes, dental implant therapy has been considered a contraindication. Hyperglycemia augments the severity of periodontal disease, and glycemic control is an essential variable in determining the success of dental implants in subjects with diabetes. Subjects with well-controlled diabetes may not be significantly compromised and can have high dental implant success rates compared to individuals with poorly controlled diabetes. The focused questions addressed in this systematic review were as follows: Can patients with diabetes be good candidates for dental implant therapy? And how does hyperglycemia and glycemic control influence osseointegration?
A systematic literature search of MEDLINE/PubMed articles published from 1982 up to and including July 2009 was independently performed by two investigators. In addition, reference lists of original and review articles were searched. The search strategy was to use the following terms in different combinations: dental implants, immediate implants, osseointegration, periodontal disease, diabetes, hyperglycemia, metabolic control, and glycemic control. The search included studies on humans and diabetes-induced animal models. The selection criteria included all levels of available evidence. Suitable variables included the implant survival rate among individuals with diabetes, effects of hyperglycemia and glycemic control on bone, and maintenance of dental implants in subjects with diabetes. Articles published only in the English language were considered, and unpublished data were not sought.
We initially identified 33 studies. Fifteen studies, which did not fulfill the selection criteria, were excluded. The included studies reported that poorly controlled diabetes negatively affects implant osseointegration; however, under optimal serum glycemic control, osseointegration can successfully occur in patients with diabetes. Animal studies have confirmed that osseointegration can be successfully achieved in insulin-controlled rats with diabetes, whereas in uncontrolled rats with diabetes, the bone-to-implant contact appears to decrease with time. The use of antiseptic mouthrinses and oral-hygiene maintenance helps in achieving a successful dental implant osseointegration in subjects with diabetes.
A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control (serum glycemic level and hemoglobin A1c in normal range) in a similar manner as in subjects without diabetes.
种植治疗是传统固定/可摘修复器械的一种有吸引力的替代方法。在糖尿病患者中，牙种植治疗曾被视为禁忌。高血糖会加重牙周疾病的严重程度，血糖控制是决定糖尿病患者牙种植成功与否的一个关键变量。与糖尿病控制不佳的个体相比，糖尿病控制良好的患者可能不会受到显著影响，且牙种植成功率较高。本系统评价所关注的问题如下：糖尿病患者能否成为牙种植治疗的合适候选者？高血糖和血糖控制如何影响骨整合？
两名研究者独立对1982年至2009年7月期间发表在MEDLINE/PubMed上的文章进行了系统的文献检索。此外，还检索了原始文章和综述文章的参考文献列表。检索策略是将以下术语以不同组合使用：牙种植体、即刻种植体、骨整合、牙周疾病、糖尿病、高血糖、代谢控制和血糖控制。检索包括对人类和糖尿病诱导动物模型的研究。选择标准包括所有可用证据水平。合适的变量包括糖尿病患者的种植体存活率、高血糖和血糖控制对骨的影响以及糖尿病患者牙种植体的维持情况。仅考虑以英文发表的文章，未检索未发表的数据。
我们最初识别出33项研究。15项不符合选择标准的研究被排除。纳入的研究报告称，糖尿病控制不佳会对种植体骨整合产生负面影响；然而，在最佳血清血糖控制下，糖尿病患者也能成功实现骨整合。动物研究证实，糖尿病胰岛素控制的大鼠能够成功实现骨整合，而糖尿病未控制的大鼠中，骨与种植体的接触似乎会随时间减少。使用抗菌漱口水和保持口腔卫生有助于糖尿病患者成功实现牙种植体骨整合。
代谢控制良好（血清血糖水平和糖化血红蛋白在正常范围内）的糖尿病患者能够以与非糖尿病患者相似的方式成功实现牙种植体骨整合。
