Abstract
Introduction:
Optimal glycemic control is crucial to dental implant long-term functional
and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good
glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists
do not consider patients with poor glycemic control candidates for implant therapy due to higher
implant failure, infection or other complications.
Aim:
This review challenges the concept of one size fits all and aims to critically appraise the evidence
for the success or failure rate of dental implants and peri-implant health outcomes in patients
with less than optimal glycemic control.
Discussion:
Evidence suggests that estimating glycemic control from HbA1c measurement alone
is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality
and morbidity after major surgical procedures. Literature for the survival or success of implants in
diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection
and outcomes. While a number of studies report that implant treatment in patients with well controlled
diabetes has a similar success rate to healthy individuals, other studies suggest that the quality
of glycemic control in diabetic patients does not make a difference in the implant failure rate or
marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may
contribute to the survival of implants in diabetic patients.
Conclusion:
In the era of personalized medicine, the clinician should utilize individualized information
and analyze all risk factors to provide the patient with evidence-based treatment options.