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diabetes mellitus with varying glycemic
control
A pilot study


Scott Dowell, DDS, MS; Thomas W.
Oates, DMD, PhD; Melanie Robinson, DDS, MS
Submitted by Dr. Gedaliah M.
Stern

DISCUSSION
The importance of maintaining
stringent glycemic control to minimize some of the most
common diabetic
comorbidities is becoming increasingly appreciated.16 Despite these
advances,
however, a majority of patients with diabetes still are unable to maintain
adequate
glycemic control.17-19 Diabetes mellitus remains a relative
contraindication to dental implant
therapy that depends on the patient’s
level of glycemic control. As a result, many patients who
have poorly
controlled diabetes may be denied the benefits of implant
therapy.

Patients with diabetes have increased frequency of periodontitis
and tooth loss, which can
lead to compromises in chewing function and diet.
The benefits of implant therapy may be
even more relevant to patients with
diabetes who are at an increased risk of experiencing tooth loss
and who are
critically dependent on managing their diabetes through diet. In fact, the
patients
who are most compromised may gain the most from implant therapy.
Given the potential for
patients with diabetes to benefit from implant based
tooth replacement, we designed this study
to enhance the understanding of
both the limitations of and the possibilities for implant therapy
in patients
with diabetes by evaluating the impact of glycemic control on implant success
and
complications after placement in these patients.

Glycemic control
in patients with diabetes is variable. The subjects enrolled in our study
were
being followed by their practicing physicians, and their physicians made
no alterations in their care
due to their participation in our study. This
gave us a reasonably realistic view of the difficulties of
managing diabetes
in these subjects. We saw that almost one-half of the subjects changed
HbA1c
level groups over the four-month study period, with the greatest
changes found in the subjects
with less well-controlled diabetes. This
variability reinforces the importance of understanding the
impact of glycemic
control on both short- and long-term aspects of implant care. Our
findings
also suggest that subjects with relatively low HbA1c levels may have
dramatic changes in
glycemic levels with the potential to affect implant
success.

Though the results of our preliminary study do not support a
detrimental effect
of hyperglycemia on implant success, this remains a
possible explanation for the inconsistencies
found in previous studies of
implant success in patients with diabetes.

Background.

The authors conducted a prospective cohort study to explore the relationship
between implant success and glycemic control in patients with type 2 diabetes
mellitus.

Results.
The HbA1c levels of the subjects
ranged from 4.5 to 13.8 percent.
All 50 implants were integrated clinically.
The authors identified
three minor complications in three patients having
HbA1c levels ranging
from 7.4 to 8.3 percent. None of these complications
affected the clinical
management of the cases, and the authors did not
identify any adverse
events.

Conclusions.
There
was no evidence of diminished clinical success or
significant early healing
complications associated with implant therapy
based on the glycemic control
levels of subjects with type 2 diabetes
mellitus
.
Clinical
Implications.

These findings support the continued
investigation
of the effects of glycemic control on implant therapy toward
the
development of therapeutic guidelines that will optimize implant
therapy
in patients with diabetes.

Dr. Dowell is in private practice,
Abilene, Texas. When this article was written, he was a graduate student in
biomedical sciences and funny pictures periodontics, Department of Periodontics, University of
Texas Health Science Center at San Antonio.
Dr. Oates is an associate
professor, Department of Periodontics, University of Texas Health
Science
Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas
78229-3900, e-mail “oates@
uthscsa.edu. Address reprint requests to Dr.
Oates.
Dr. Robinson is in private practice, Austin, Texas. When this article
was written, she was a graduate
student in periodontics, Department of
Periodontics, University of Texas Health Science Center at
San
Antonio.
DISCLOSURE:
The ITI Foundation, Basel,
Switzerland, and the San Antonio Area
Foundation provided financial support
for this study. Dr. Jim Simpson and the Institute
Straumann AG, Waldenburg,
Switzerland, provided the implants used in this study. Dr.
Oates has
participated in research sponsored by Institute Straumann AG and
presented
findings.
A pilot study
Scott Dowell, DDS, MS; Thomas W.
Oates, DMD, PhD; Melanie Robinson, DDS, MS
JADA C ONTI NUI N G E D U CA T I O
N
Copyright 2007 American Dental Association. All rights reserved.

href="http://www.jewishdiabetes.com/alon/Implantsuccessinpeoplewithtype2diabetes.pdf">For
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