Insulin used for diabetes disease and its treatment does not constitute an obstacle or danger for intraoral surgical interventions. Patients with diabetes should measure their fasting blood sugar levels the day before going to the dentist and on the morning of surgical intervention. In uncontrolled diabetes and high blood sugar level, wound healing is delayed, the possibility of inflammation increases.
Osseointegration is the most important factor in long-term implant success.1
Proinflammatory cytokines (IL-1β, TNF-α), which play a role in the pathogenesis of periodontitis and stimulate bone resorption, also play a role in the pathogenesis of peri-implantitis. 2
Proinflammatory cytokines and systemic inflammation are effective in diabetic pathogenesis, and it poses a great risk for osseointegration success after implant applications. It has been accepted as a contraindication for long-term implant treatment. This view came after the NIH Dental Implant Consensus Conference in 1988. 3
The patient’s toughness blood sugar level is below 180 mg/dl before any surgical intervention. Surgical interventions create stress in patients and stress raises blood sugar. For this reason, patients with diabetes should be motivated before and after the operation and should be supported with pain relief and sedatives. Such patients need to perform their procedures under local anesthesia in the early morning hours. The treatment should not disrupt the patient’s diet and medication hours.
While diabetic patients under control were considered suitable for the implant, patients who did not have a good glycemic control could not benefit from implant treatment. The success of the implant depends on the realization of osseointegration following placement. In the long term success after the application of the prosthesis, the alveolar bone trabecular structure that will meet the functional forces on the implant becomes important. 4
The importance of bone metabolism in long-term implant success may be the weak link of the chain, especially in diabetic patients. 5
Various biomaterials are used to accelerate the process of osseointegration and strengthen the bone. platelet-rich plasma (PRP), melatonin + fibroblast growth factor 2 (rhFGF-2), recombinant human morphogenetic protein 2 (rhBMP-2), TGF-beta 1, BMP-7, Bisphosphonates 6
As a result of various clinical evaluations on patients with type 1 diabetes, a decrease in bone density and a change in tissue regeneration have been reported. 7
The effect of type 2 diabetes on bone tissue regeneration process is uncertain. Various studies have shown that it is not different from patients without diabetes in terms of bone density and fracture rate. 8
Diabetes has been shown to increase the level of periodontal disease and thus loss of teeth. 9
Another complication of diabetes is tooth loss and limited function, as well as decreased quality of life. 11
Toothlessness causes a dramatic drop in oral health. A decrease in chewing function also affects dietary habits that are effective in the glycemic control of the disease. 12
Many studies have demonstrated that there is a strong relationship between reduced chewing function and the number of vegetables, fruits, meats and bread taken by edentulous patients. Decreased intake of healthy foods leads to a breakdown in the diet of vitamins, minerals, fiber, and protein. This condition is compensated by toothless patients with a diet rich in cholesterol and fat. 13
Aging populations with type 2 diabetes and tooth loss benefit enormously from implant therapy.
Although the necessity of implant treatment for oral rehabilitation of diabetes patients is clear, the benefits to be obtained are still not fully clarified. 14
Thanks to implant applications, the freedom of toothless patients will enable them to eat fresh and healthier foods. Patients who have difficulty in maintaining glycemic control due to loss of chewing function will perhaps be the ones who benefit most from this job by restoring teeth and chewing function. Recent studies with well-defined parameters for glycemic control for implant success support the view that implant application poses a minimal risk in patients with diabetes, independent of glycemic control. 15
Oral health is an important part of general health and healthy nutrition. Tooth loss in diabetic patients also affects nutrition, which is very critical for overall control of diabetes. 16
Good glycemic control is associated with a good chewing function. Elimination of tooth loss with implant applications contributes to the improvement of patients’ diabetic status. The relationship of implant losses with glycemic control in the literature is not very clear. In recent studies, the necessity of implant treatment has been revealed even in people with poor glycemic control, but the delay in osseointegration should be considered. It will be easier and more enjoyable to maintain oral health and live with its teeth with controlled nutrition, regular medication, neglected mouth cleaning, and dentist controls.
1 ”Özdemir et al 19
2 Ataoglu et al 2002
3 National Institutes of Health Consensus Development Conference 1988, World Workshop in periodontics 1996, Blanchaert 1998, Wilson & Higginbottom 1998, Beikler & Flemmig 2003, Kotsovilis, et al. 2006, Javed & Romanos 2009
4 Thomas W. Oates et al. 20
5 Thomas W. Oates et al. 2013
6 Smith 1995, Fontana et al 2004, Courtney et al, 2005, Becker et al 2006 Takechi et al 2008
7 Krakauer, et al. 1995, Hampson, et al. 1998, Christensen & Svendsen 1999, Campos Pastor, et
get. 2000, Kemink, et al. 2000, Espallargues, et al. 2001, Valerio, et al. 2002, Heilman, et al. 2009
8 Barrett-Connor & Holbrook 1992, Bauer, et al. 1993, van Daele, et al. 1995, Forsen, et al. 1999, Tuominen, et al. 1999, Nicodemus & Folsom 2001, Sosa, et al. 2009
9 Emrich, et al. 1991, Safkan-Seppala & Ainamo 1992, Oliver & Tervonen 1993, Collin, et al.
1998, Oliver, et al. 1998
10 McGrath & Bedi 2001
12 Kawamura, et al. 2001, Nuttall, et al. 2003, Roumanas, et al. 2003, Savoca, et al. 2010
13 Osterberg & Steen 1982, Appollonio, et al. 1997, Ritchie, et al. 1997, Papas, et al. 1998, Mojon, et al. 1999, Sheiham, et al. 2001, Hutton, et al. 2002, Savoca, et al. 2010
14 Thomas W. Oates et al. 2013
15 Thomas W. Oates et al. 2013
16 Touger-Decker & Mobley 2003