Poorly controlled diabetes mellitus as a risk factor for peri-implantitis
Näytönastekatsaukset
11.2.2025
Level of evidence: C
Poorly controlled diabetes mellitus may increase the risk for peri-implantitis.
The evidence is mainly supported by cohort and case-control studies and systematic reviews/meta-analysis. Imprecision in results. The role of a long term unstable DM is difficult/unethical to study, because the goal of DM treatment is stable glycemic status.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 »1 | SR/MA | The efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients Interventional and observational studies up to 8/2022 with at least 6 months of follow-up, overall 48 studies included | Preventive factors studied: Glycemic control Smoking cessation Supportive periodontal/peri-implant protocol and compliance Soft tissue augmentation Oral hygiene Bruxism control | Occurrence of peri-implant mucositis and/or peri-implantitis at implant or patient level For SPT also implant survival | Imprecision in results (wide confidence-intervals) on DM/glycemic control |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »2 | SR/MA | publications from January 1980 until March 2016 on 9 databases: 32 cross-sectional studies, 10 case-control studies, 7 prospective cohort studies, 3 cohort studies, 2 cross-sectional retrospective studies, 1 randomized controlled trial, 1 non-randomized controlled trial and 1 retrospective cohort study. Peri-implantits prevalence/incidence and risk factors reported | Smokers and former smokers compared to non-smokers DM patients compared to non-diabetics Patients participating/not participating prophylaxis program Patients having/not having periodontitis or history of periodontitis | Prevalece of peri-implantitis | Imprecision in results among DM patients (wide confidence-intervals) Indirectness in maintenance treatment Heterogenity in studies on periodontitis or history of periodontitis prevented meta-analysis |
| «Wagner J, Spille JH, Wiltfang J, ym. Systematic review on diabetes mellitus and dental implants: an update. Int J Implant Dent 2022;8(1):1 »3 | SR | 56 studies; 40 clinical studies 16 reviews | Diabetic patients compared to non-diabetics | Complication rate; peri-implantitis and implant loss | |
| Reference | Comments |
|---|---|
| «Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 »1 | Glycemic control was considered poor with HbA1c >8 %. Mean implant survival rate may be considered as acceptable in both (unstable and stable DM) groups; 95.6% and 99%, respectively. However, follow-up times were as short as 1-3 y in 5 of the included studies, including 1 study in meta-analysis. Irregular SPT decreased implant survival OR 3.76 (1.5 – 9.45). The role of a long term unstable DM is difficult/unethical to study, because the goal of DM treatment is stable glycemic status. |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »2 | Meta-analysis on smoking, included one study of former smokers, in which OR was 0,34 (0,01-9,95), No meta-analysis on profylaxis program because of heterogenity among studies. Lack of professional maintenance was the primary outcome only in 1 included study, others used indirect outcomes such as presence plaque/plaque index No meta-analysis performed on periodontitis/history of periodontitis |
| «Wagner J, Spille JH, Wiltfang J, ym. Systematic review on diabetes mellitus and dental implants: an update. Int J Implant Dent 2022;8(1):1 »3 | No meta-analysis, narrative review |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 »1 | 11 studies on glycemic control at implant level. 2 studies in meta-analysis of prevalence of peri-implantitis | 1-7 y, 2-3,5 y in studies icluded in meta-analysis | poor glycemic control 10/212 | good glycemic control 1/173 | diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95 % confidence interval [CI]: 0.03–0.96; I2: 0%) compared to patients with poor glycemic control |
| «Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 »2 | 5 studies, 667 patients in meta-analysis | not reported for studies on DM, overall from 6 months to 16 years | OR 2.5; 95% CI 1.4-4.5) | ||
| «Wagner J, Spille JH, Wiltfang J, ym. Systematic review on diabetes mellitus and dental implants: an update. Int J Implant Dent 2022;8(1):1 »3 | patients with poorly controlled diabetes mellitus suffer more often from peri-implantitis, especially in the post-implantation time. Moreover, these patients show higher implant loss rates than healthy individuals in long-term. Whereas, under controlled conditions success rates are similar | ||||
| Level of evidence: low (C) The quality of evidence is downgraded due to inconsistency, imprecision (wide confidence intervals), and upgraded due to strong effect | |||||
References
- Carra MC, Blanc-Sylvestre N, Courtet A, ym. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023;50 Suppl 26():77-112 «PMID: 36807599»PubMed
- Dreyer H, Grischke J, Tiede C, ym. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018;53(5):657-681 «PMID: 29882313»PubMed
- Wagner J, Spille JH, Wiltfang J, ym. Systematic review on diabetes mellitus and dental implants: an update. Int J Implant Dent 2022;8(1):1 «PMID: 34978649»PubMed