Comparison of peri-implant soft tissue and crestal bone status of dental implants placed in prediabetic, type 2 diabetic, and non-diabetic individuals: a retrospective cohort study.
ABSTRACT: BACKGROUND:Clinicoradiographic status of narrow-diameter implants (NDIs) among patients with prediabetes and type 2 diabetes mellitus (DM) is scarce. The aim was to address the clinicoradiographic status of NDIs placed prediabetic, type 2 diabetic, and non-diabetic individuals. In this retrospective cohort study, patients having undergone oral rehabilitation with NDI were included. The participants were divided into the following: (a) patients with prediabetes; (b) patients with poorly controlled type 2 DM; (c) patients with well-controlled type 2 DM; and (d) normoglycemic individuals. Demographic data was collected. In all groups, peri-implant plaque index (PI), gingival index (GI), probing depth (PD), and mesiodistal CBL were measured in all groups. Information related to implant dimensions, surface characteristics, insertion torque, implant geometry, duration of NDI in function, and jaw location of NDI was also recorded. Data normality was assessed and group comparisons were performed. A probability value under 0.01 was considered statistically significant. RESULTS:Eighty-three patients (20 patients had prediabetes, 22 with poorly controlled type 2 DM, 20 with well-controlled type 2 DM, and 20 self-reported non-diabetic individuals) were included. The mean HbA1c levels were significantly higher among patients with prediabetes (P < 0.01) and poorly controlled type 2 DM (P < 0.01) than patients with well-controlled type 2 DM and non-diabetic controls. Peri-implant PI, GI, PD, and mesiodistal CBL levels were significantly higher among patients with pre-diabetes (P < 0.01) and poorly controlled type 2 DM (P < 0.01) than patients with well-controlled type 2 DM and non-diabetic controls. Peri-implant PI, GI, PD, and mesiodistal CBL levels were significantly higher among patients with poorly controlled type 2 DM (P < 0.01) than patients with prediabetes. CONCLUSION:Chronic hyperglycemia increases the risk of peri-implant diseases around NDIs.
Project description:Context:Therapy with somatostatin analogues (SSAs) may have deleterious effects on glucose metabolism in patients with acromegaly, often leading to the development of diabetes mellitus (DM). Aim:The aim of the study was to evaluate whether DM, developed during therapy with SSAs, may revert after drug withdrawal and cure of acromegaly with pituitary adenomectomy. Design:Retrospective cohort study, in a tertiary referral centre. Patients:Eighteen acromegalic patients without DM at the diagnosis of acromegaly treated with SSAs as a primary therapy, and then cured by pituitary adenomectomy. Methods:Endocrine status and glucose homeostasis were evaluated at diagnosis of acromegaly and at least every 6 months during SSA therapy. At each visit, patients were classified into one of the following classes: normal glucose tolerance, prediabetes, overt diabetes. Results:Median follow-up after starting SSAs therapy was 69 months (IQR 54.75-132.25). During SSA therapy, all patients had controlled acromegaly defined by normal serum IGF1 concentrations for the age. Of the 13 euglycaemic patients at diagnosis, three developed prediabetes and three diabetes, whereas, of the five prediabetic patients at diagnosis, two worsened to overt diabetes and three remained in the prediabetic range (P = 0.04). After curing acromegaly with pituitary adenomectomy and subsequent SSA withdrawal, prediabetes reverted in five of six patients, and diabetes in all five patients (three reverted to euglycaemia, while two reverted to prediabetes) (P = 0.01). Conclusions:In acromegalic patients with controlled disease, changes in glycaemic status induced by SSAs are not permanent.
Project description:<h4>Objective</h4>To assess the accuracy of half-way digital mucosa-supported implant guides (HDMIGs) for edentulous jaws.<h4>Methods</h4>Ninety-five consecutive patients (859 implants) with edentulous jaws who underwent implant placement using an HDMIG from July 2012 to June 2018 were retrospectively identified. The primary endpoint was implant-related complications (nerve injury and unexpected perforation), and the secondary endpoints were the faciolingual distance, mesiodistal distance, buccolingual angle, and mesiodistal angle. Follow-ups occurred at 1 month, 2 months, and then every 2 months following implant placement.<h4>Results</h4>Twenty-seven (28.4%) patients met the exclusion criteria, leaving 68 eligible patients (636 implants) for the final analysis. The median follow-up was 24 months (range, 18-27 months). No patients developed nerve injury, revision, or unexpected perforation. At the final follow-up, the mean faciolingual distance was 0.65 ± 0.16 mm, the mean mesiodistal distance was 1.16 ± 0.61 mm, the mean buccolingual angle was 4.04° ± 2.26°, and the mean mesiodistal angle was 3.75° ± 2.56°. In the comparison of the first month after surgery and the last follow-up, no significant differences were detected in any of the four measured variables.<h4>Conclusion</h4>Use of an HDMIG may be a convenient and safe method to ensure correct implantation.
Project description:<h4>Objective</h4>To compare using autogenous bone with or without bioactive glass in ridge splitting of horizontal bone defects combined with simultaneous implant placement.<h4>Materials and methods</h4>In control group, bone expansion was performed and autogenous bone was used to augment the intercortical bone defect. In study group, autogenous bone was mixed with bioactive glass (1 : 1 in volume). In both groups, the implants were inserted simultaneously with ridge splitting. Six months following implant insertion, bone width and height were evaluated. Statistical analysis utilizing paired Student's <i>t</i>-test was used for comparing results within the same group, whereas independent samples <i>t</i>-test was used for intergroup variables comparison.<h4>Results</h4>The mean bone width and labial and mesiodistal crestal bone height values were increased significantly in both groups from baseline to 6 months postoperatively. Comparing the two groups showed nonstatistical significant difference regarding the labial crestal bone loss, while the ridge width gain values were significantly higher in the study group than in the control group. The mesiodistal bone loss was significantly higher in control group than in study group.<h4>Conclusion</h4>Autogenous bone was mixed with bioactive glass (1 : 1 in volume) to fill intercortical defect created after ridge splitting to decrease peri-implant bone resorption associated with autogenous bone alone. This trial is registered with clinical trial registration: NCT04814160.
Project description:<h4>Purpose</h4>To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis.<h4>Material and methods</h4>Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched.<h4>Results</h4>Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = - 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = - 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = - 28.09%; p = 0.01 and WMD = - 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to - 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = - 1.47 mm; p = 0.01), PD (- 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = - 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = - 11.11%; p = 0.11).<h4>Conclusions</h4>Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.
Project description:<i>Background and Objectives</i>: Peri-implantitis treatment is still undefined. Regenerative treatment is expensive and technically demanding due to the need to handle biomaterials, membranes and different methodologies of decontamination. Resective treatment and implantoplasty might be a viable solution. This case series presents a 24 month retrospective observational study of 10 peri-implantitis patients treated with implantoplasty. <i>Materials and Methods</i>: In the present case series, 10 peri-implantitis patients (20 implants) were treated with a resective approach and implantoplasty. Previous to implantoplasty, all patients underwent non-surgical treatment. This surgery consisted in a full-thickness flap and implant surface exposure. The exposed non-osseointegrated implant body was submitted to implantoplasty. The flap was apically repositioned and sutured. Patients were accompanied for 24 months. <i>Results</i>: The mean initial probing depth (PD) (PD = 5.37 ± 0.86 mm), bleeding on probing (BoP = 0.12 ± 0.06%) and suppuration (Sup = 0.01 ± 0.01%) decreased significantly at the 12 month evaluation (PD = 2.90 ± 0.39 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Between the 12 and 24 month evaluations, there were no significant clinical changes (PD = 2.85 ± 0.45 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Mucosal recession (MR) had a significant increase between the baseline and the first 12 months (0.69 ± 0.99 mm vs. 1.96 ± 1.33 mm), but there were no significant changes between the 12th and 24th month (1.94 ± 1.48 mm). The success rate was 100% without implant fracture or loss. <i>Conclusions</i>: Resective surgery and implantoplasty might be a valid option in some specific peri-implantitis cases. Properly designed clinical trials are needed to confirm this possibility.
Project description:Diabetes mellitus (DM) and abnormal glucose metabolism are associated with cardiovascular (CV) disease. We investigated the prevalence and prognostic importance of dysglycaemia in patients with acute coronary syndromes (ACS) in the PLATelet inhibition and patient Outcomes (PLATO) trial. Diabetes was defined as known diabetes or HbA1c???6.5% or non-fasting glucose???11.1 mmol/L on admission, prediabetes as HbA1c???5.7% but <?6.5%, and no diabetes as HbA1c?<?5.7%. The primary endpoint was the composite of CV death, spontaneous myocardial infarction type 1 (sMI) or stroke at 12 months. Multivariable Cox regression models, adjusting for baseline characteristics, and biomarkers NT-proBNP and troponin I, were used to explore the association between glycaemia and outcome. On admission, 16,007 (86.1%) patients had HbA1c and/or glucose levels available and were subdivided into DM 38.5% (6160) (1501 patients had no previous DM diagnosis), prediabetes 38.8% (6210), and no DM 22.7% (3637). Kaplan Meier event rates at 12 months for CV death, sMI or stroke per subgroups were 14.5% (832), 9.0% (522), and 8.5% (293), respectively with multivariable adjusted HRs, versus no diabetes, for diabetes: 1.71 (1.50-1.95) and for prediabetes 1.03 (0.90-1.19). Corresponding event rates for CV death were 6.9% (391), 3.4% (195) and 3.0% (102), respectively, with adjusted HRs for patients with DM of: 1.92 (1.42-2.60) and for prediabetes 1.02 (0.79-1.32). Abnormal glucose metabolism is common in ACS patients, but only patients with definite DM have an increased CV risk, indicating that prediabetes is not immediately associated with worse CV outcomes.
Project description:Type 2 (T2DM) is believed to be common in Saudi Arabia, but data are limited. In this population survey, we determined the prevalence of T2DM and prediabetes.A representative sample among residents aged ≥ 18 years of the city of Jeddah was obtained comprising both Saudi and non-Saudi families (N = 1420). Data on dietary, clinical and socio-demographic characteristics were collected and anthropometric measurements taken. Fasting plasma glucose and glycated hemoglobin (HbA1c) were used to diagnose diabetes and prediabetes employing American Diabetes Association criteria. Multiple logistic regression analysis was used to identify factors associated with T2DM.Age and sex standardized prevalence of prediabetes was 9.0% (95% CI 7.5-10.5); 9.4% (7.1-11.8) in men and 8.6% (6.6-10.6) in women. For DM it was 12.1% (10.7-13.5); 12.9% (10.7-13.5) in men and 11.4% (9.5-13.3) in women. The prevalence based on World Population as standard was 18.3% for DM and 11.9% for prediabetes. The prevalence of DM and prediabetes increased with age. Of people aged ≥50 years 46% of men and 44% of women had DM. Prediabetes and DM were associated with various measures of adiposity. DM was also associated with and family history of dyslipidemia in women, cardiovascular disease in men, and with hypertension, dyslipidemia and family history of diabetes in both sexes.Age was the strongest predictor of DM and prediabetes followed by obesity. Of people aged 50 years or over almost half had DM and another 10-15% had prediabetes leaving only a small proportion of people in this age group with normoglycemia. Since we did not use an oral glucose tolerance test the true prevalence of DM and prediabetes is thus likely to be even higher than reported here. These results demonstrate the urgent need to develop primary prevention strategies for type 2 diabetes in Saudi Arabia.
Project description:The aim of the present study was to identify the peri-implant conditions (bleeding on probing (BOP), pocket probing depth (PPD), modified plaque index (mPI)) and marginal bone loss (MBL, marginal bone level change between follow-up and occlusal loading) around cemented and screw-retained posterior single crowns on tissue-level implants. The study was a retrospective cohort study with up to 4 years (mean 2.5 years) follow-up. Patients with either cemented or screw-retained crowns in posterior regions were included. Implant survival, technical complications, BOP, PPD, mPI, MBL, biologic complications (peri-implant mocositis and peri-implantitis) were evaluated. Mann-Whitney U test was used to test the difference between the screw-retained group (SG) and cemented group (CG). 176 patients (SG: 94, CG: 82) were included. The implant survival rates were 100% in SG and 98.8% in CG. Prosthetic screw loosening was found in 8 restorations (8.7%) at follow-up visit. Peri-implant mucositis rate was significantly higher in the SG group (42.1%) than that in the CG group (32.2%) (P = 0.04). Six patients (6.38%) in the screw-retained group and 5 patients (6.10%) in the cemented group were diagnosed with peri-implantitis, the difference did not reach statistical significance (P>0.05). No significant difference of PPD, mPI and MBL were found between two groups (P = 0.11, 0.13 and 0.08, respectively). High implant survival rates were achieved in both groups. Cemented single crowns on tissue-level implants showed comparable peri-implant conditions in comparison with two-piece screw-retained crowns. Well-designed prospective cohort or randomized controlled clinical trials with longer follow-up are needed to confirm the result.
Project description:<h4>Purpose</h4>This study investigated the effects of hyaluronic acid (HA) on peri-implant clinical variables and crevicular concentrations of the proinflammatory biomarkers interleukin (IL)-1? and tumor necrosis factor (TNF)-? in patients with peri-implantitis.<h4>Methods</h4>A randomized controlled trial was conducted in peri-implantitis patients. Patients were randomized to receive a 0.8% HA gel (test group), an excipient-based gel (control group 1), or no gel (control group 2). Clinical periodontal variables and marginal bone loss after 0, 45, and 90 days of treatment were assessed. IL-1? and TNF-? levels in crevicular fluid were measured by enzyme-linked immunosorbent assays at baseline and after 45 days of treatment. Clustering analysis was performed, considering the possibility of multiple implants in a single patient.<h4>Results</h4>Sixty-one patients with 100 dental implants were assigned to the test group, control group 1, or control group 2. Probing pocket depth (PPD) was significantly lower in the test group than in both control groups at 45 days (control 1: 95% CI, -1.66, -0.40 mm; control 2: 95% CI, -1.07, -0.01 mm) and 90 days (control 1: 95% CI, -1.72, -0.54 mm; control 2: 95% CI, -1.13, -0.15 mm). There was a trend towards less bleeding on probing in the test group than in control group 2 at 90 days (<i>P</i>=0.07). Implants with a PPD ?5 mm showed higher levels of IL-1? in the control group 2 at 45 days than in the test group (<i>P</i>=0.04).<h4>Conclusions</h4>This study demonstrates for the first time that the topical application of a HA gel in the peri-implant pocket and around implants with peri-implantitis may reduce inflammation and crevicular fluid IL-1? levels.<h4>Trial registration</h4>ClinicalTrials.gov Identifier: NCT03157193.
Project description:In this study we want to ascertain the differences and similarities of infected and inflammated peri implant tissue versus healthy peri implant tissue at the mRNA level. Six of the patients where affected by periimplantitis. In situ dental implants where explanted because of inflammation and non-integration. From two patients, implants were explanted because of wrong placement. They where classified as implants with healthy periimplant tissue.