Implant Survival in Patients With Type 2 Diabetes: Placement to 36 Months

Background: Because the life expectancy of individuals continues to increase, dentists providing dental implant treatment can expect to see an increasing number of patients with diabetes mellitus. Today, there are little data available concerning the clinical outcomes involving the use of implant treatment for patients with diabetes mellitus. There are three types of diabetes mellitus: Type 1 (insulin dependent), Type 2 (non-insulin dependent), and gestational. Because of possible complications from patients with diabetes mellitus, they are excluded from participation in most clinical studies of endosseous dental implant survival.

Methods: This study attempted to determine if Type 2 diabetes represents a significant risk factor to the long-term clinical performance of dental implants, using the comprehensive DICRG database. Diabetes was a possible exclusion criterion; however, the final decision on Type 2 patients was left to the dental implant team at the research center. A total of 2,887 implants (663 patients) were surgically placed, restored, and followed for a period of 36 months. Of these, 2,632 (91%) implants were placed in nondiabetic patients and 255 (8.8%) in Type 2 patients. Failures (survival) were compared using descriptive data. Possible clustering was also studied.

Results: A model assuming independence showed that implants in Type 2 patients have significantly more failures (P = 0.020). However, if correlations among implants within the patient are considered, the significance level becomes marginal (P = 0.046). The experience of the surgeon did not produce a clinically significant improvement in implant survival. The use of chlorhexidine rinses following implant placement resulted in a slight improvement (2.5%) in survival in non-Type 2 patients and a greater improvement in Type 2 patients (9.1%); the use of preoperative antibiotics improved survival by 4.5% in non-Type 2 patients and 10.5% in Type 2 patients. The use of HA-coated implants improved survival by 13.2% in Type 2 diabetics.

Conclusion: Type 2 diabetic patients tend to have more failures than non-diabetic patients; however, the influence was marginally significant. These findings need to be confirmed by other scientific clinical studies with a larger Type 2 diabetic sample size.Ann Periodontol 2000;5:157-165.