Association between peri-implantitis and diabetes

Background + Aims

• Peri-implant diseases (PIDs), including peri-implant mucositis and peri-implantitis, are significant complications that can arise following dental implant placement. These conditions are characterised by inflammation of the peri-implant tissues, which can lead to implant failure if not managed effectively.
• The increasing prevalence of dental implants necessitates a better understanding of preventive strategies to maintain peri-implant health.
• Risk factors such as diabetes, smoking, and poor oral hygiene have been identified as contributors to the development of these diseases. However, there is a lack of direct evidence regarding the efficacy of primordial (prior to implant placement) and primary preventive (once the implant is placed) interventions specifically designed to mitigate these risks.
• This systematic review aims to synthesise existing literature to assess the efficacy of risk factor control in preventing PIDs by analysing observational and interventional studies.

Materials + Methods

• A comprehensive search was conducted across multiple databases, yielding 7,565 records, which were screened for relevance.
• After applying inclusion and exclusion criteria, 48 studies were selected for analysis, focusing on various risk factors associated with PIDs.
• The Newcastle-Ottawa Scale (NOS) was used for cohort studies, while the Cochrane risk-of-bias tool (RoB-2) was applied to randomised controlled trials (RCTs).
• Data were extracted on study characteristics, risk factors, and outcomes, with a focus on glycaemic control, smoking, and other relevant factors.
• Meta-analyses were performed using random effect models to account for inter-study heterogeneity, with significance set at p < 0.05.

Results

• The review included 48 studies published between 2000 and 2022, with varying designs and methodologies.
• Evidence indicated that controlling risk factors positively impacted peri-implant health.
• In regards to diabetes, they analysed 11 observational studies – 5 cohorts + 6 case-control studies and found:
  • Pooled data analysis showed patients with good glycaemic control had:
    • Significantly lower rate of peri-implantitis (OR = 0.16).
    • Significantly lower MBL changes over time (MD: -0.36mm).
    • No statistically significant difference in probing pocket depths (PPD) and bleeding on probing (BOP) in good vs poorly controlled diabetics.
  • 2 studies, including 309 implants, observed implant loss and were used for meta-analysis.
    • Diabetes patients with poor glycaemic control have 7.59 times increased risk of implant failure vs patients with good control (OR: 7.59).
  • 5 studies (253 implants)
    • Estimated mean implant survival: 99% (patients with good glycaemic control) vs 95.6% in patients with poor glycaemic control (5 studies and 271 implants).
  • 2 studies evaluated biomarkers in the peri-implant sulcular fluid.
    • 1 study found osteoprotegerin (OPG) was significantly lower in poorly controlled diabetes patients vs non-diabetes patients.
    • Another study found a positive correlation between advanced glycation end products and PPD and marginal bone levels in patients with poor glycaemic control, supporting a compromised peri-implant state in these patients.
  • Effect size is considered clinically relevant, but it must be highlighted that the results are based on a limited number of studies with small sample sizes, analyses were performed at implant level only, and the definition of good and poor glycaemic control was inconsistent in studies.
  • Consistency found in the overall results, favouring good glycaemic control over poor glycaemic control.

Limitations