THE EFFECT OF DIFFERENT SURFACE MODIFICATIONS ON THE OSSEOINTEGRATION OF DENTAL IMPLANT UNDER DIABETIC CONDITIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF IN VITRO RESEARCH

Abstract

Background

Osseointegration, the direct connection between bone and implant, is crucial for dental implant success, particularly in patients with diabetes mellitus (DM) where impaired bone healing poses a challenge. Surface modifications of dental implants have emerged as an effective strategy to enhance osseointegration in such compromised conditions. This systematic review aimed to evaluate the impact of various surface modifications on the osseointegration of dental implants under diabetic conditions, with a focus on alkaline phosphatase (ALP) activity, osteopontin (OPN) and osteocalcin (OCN) as markers of osteogenic potential.

Methods

This review was conducted following PRISMA guidelines and included studies assessing surface modifications on dental implants in diabetic models. A comprehensive literature search was performed across PubMed, Embase, and Web of Science up to July 2024. Inclusion criteria focused on studies that incorporated in vitro experiments with quantitative measurements of bone formation. Data extraction and quality assessment were performed on eight selected studies. Statistical analysis included the calculation of Response Ratios (RR) for ALP activity, and meta-analyses of OCN and OPN expression levels measured at certain time point. The pooled results were visualized using forest plots.

Results

The included studies demonstrated a consistent increase in ALP activity across surface-modified implants, particularly at 7 and 14 days postimplantation. The 7-day RR was 2.02 (95% CI: 1.76-2.29), and the 14-day RR was 1.36 (95% CI: 1.18-1.55), indicating enhanced osteogenic potential. Similarly, OCN expression at day 7 showed a significant pooled standardized mean difference (SMD) of 11.01 (95% CI: 3.02-19.00), and OPN expression at day 7 demonstrated a more consistent effect, with a pooled SMD of 3.76 (95% CI: 2.46-5.06), all suggesting a marked upregulation of osteogenic differentiation markers. However, significant heterogeneity was observed, attributed primarily to differences in cell lines and experimental conditions.

Conclusion

Surface modifications significantly enhance osseointegration of dental implants in diabetic conditions, as evidenced by increased ALP activity and elevated expression levels of key osteogenic markers such as OCN and OPN. Despite the promising results, future research should address the heterogeneity by standardizing methodologies and expanding the number of included studies to refine these techniques and their clinical applicability.