Dental implants and diabetes: Conditions for success

Abstract

Aims

To assess the success of dental-implant treatment in patients with diabetes.

Background

Dental-implant treatment is an efficient means of replacing lost teeth. However, diabetes can be considered a relative contraindication for this type of treatment because of the slightly higher failure rate compared with populations without diabetes.

Recommendations

Prerequisite selection of suitable diabetic patients, eradication of co-morbidities (poor oral hygiene, cigarette-smoking, periodontitis), stabilization of glycaemic control (HbA_1c at around 7%) and preventative measures against infection can increase the success of dental implantation in diabetic patients to a satisfactory rate of 85–95%.

Conclusion

Implant surgery is never a matter of urgency; thus, diabetes patients with the best chances of success should be conjointly selected and prepared by both dental and diabetes clinicians.

Résumé

But

Les conditions de la pose d’implants dentaires chez le diabétique sont examinées.

État des lieux

Les implants dentaires sont un moyen efficace de remplacement des dents manquantes. Mais le diabète est encore considéré comme une contre-indication relative de ce traitement du fait d’une incidence d’échecs légèrement supérieure à celle observée dans la population non diabétique.

Recommandations

Cependant, à la condition de réunir des préalables, sélection des patients éligibles, éradications de co-morbidités (mauvaise hygiène buccodentaire, tabagisme, périodontie), stabilisation du contrôle glycémique (HbA_1c proche de 7 %) et des mesures préventives de l’infection, les chances de succès de la pose d’implants chez les patients diabétiques peuvent être satisfaisantes (85–95 %).

Conclusions

La chirurgie implantaire n’est jamais une urgence et les patients éligibles doivent être sélectionnés et préparés conjointement par le dentiste et le diabétologue.

Introduction

There is considerable evidence to suggest that periodontal disease and diabetes are linked in a reciprocating cycle. Diabetes is a risk factor for periodontitis, which appears to develop at least twice as often in diabetics as in populations without diabetes [1]. In addition, periodontal infection can affect glycaemic control in diabetic patients [2]. These coexisting conditions can lead to the gradual loss of tooth attachment to alveolar bone, resulting in tooth loss. Becoming partially or totally edentulous is the possible outcome, and is known as the “sixth complication” of diabetes. However, diabetes specialists are unfamiliar with dental pathology, and are not particularly concerned about either the prevention or cure of dental and periodontal complications, preferring to refer their patients to a dentist's expertise and care. Nevertheless, most professional recommendations suggest the usefulness of a dialogue between these two different specialists regarding diabetic patients’ dental care [3]. Indeed, diabetologists are frequently questioned by their patients or by dental clinicians regarding the indications and/or absence of contraindications for dental endosseous-implant treatment.

Dental-implant treatment is an efficient means of replacing lost teeth [4]. However, diabetes has been considered as a risky condition, as it can cause delayed healing, unstable fibrointegration and infections. Treatment can fail because of premature loss of the implant or defects in osseointegration, leading to eventual implant failure. Accordingly, diabetes remains a relative contraindication for implant therapy [5]. To improve the global success rate and reduce the risk of complications, both the identification of suitable patients for such treatment and standardization of its procedures are needed.