implants in diabetic patients-glycated haemoglobin (HbA1c) levels an important decision making parameter

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One of the most common questions that we encounter from diabetic patients who want replacement of teeth is CAN WE HAVE IMPLANTS TO REPLACE OUR MISSING TEETH?

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WELL...........the simple answer is YES, but in order to do that one has to keep the blood sugar levels under control.

The patients most often tell that they keep a check on their fasting sugar levels but here i would like to inform the diabetic people who want implants that they should have a record of their glycated haemoglobin levels during the last few months before they decide that they can have implants or not.It is a simple blood test which tells about the sugar levels during the last three months and is a better indictor of glycaemia control than the fasting or post parendial blood sugar levels.

 Glycated Hb/Hemoglobin A1c level,should be less than 7%, which is considered “well controlled”. Hemoglobin A1c from 7% to 9% is only “fairly well controlled”. Levels higher than 9% are considered out of control. Patients who would like to have dental implant surgery cannot proceed with surgery while their diabetes is out of control.though this is a complicated disease that affects everything in the body, including the teeth, the gums and the jaw bone.

   

In one study involving 45 patients with diabetes, followed for up to 12 years after implant placement and sinus bone grafts, the doctors found that well controlled (Hemoglobin A1c less than 7%) and even fairly well controlled diabetes (Hemoglobin A1c 7% to 9%) had almost the same implant success rates of 97.2%.

ANOTHER COMMON QUESTION WHICH ARISES IN THE DIABETIC PATIENTS IS THAT ....WILL THE SUGAR LEVELS INTERFERE WITH THE IMLANT OSSEOINTEGRATING WITH BONE?

Diabetes mellitus is considered a relative contra-indication for implant therapy. However, the effect of glycemic level on implant integration in persons with diabetes remains poorly understood. The hypothesis of this research was that poor glycemic control is directly related to short-term-impairment implant stabilization. This prospective clinical study evaluated 10 non-diabetic individuals (12 implants) and 20 persons with type 2 diabetes (30 implants). Glycated hemoglobin (HbA1c) levels ranged from 4.7-12.6%. Implant stability was assessed by resonance frequency analysis over 4 months following placement. Minimum stability levels were observed 2-6 weeks following placement for all 42 implants. Persons with HbA1c ≥ 8.1% had a greater maximum decrease in stability from baseline and required a longer time for healing, as indicated by return of stability level to baseline. This study demonstrates alterations in implant stability consistent with impaired implant integration for persons with type 2 diabetes mellitus in direct relation to hyperglycemic conditions.owever, there were more complications with infections, the higher the Hemoglobin A1c value.Glycemic Control and Implant Stabilization in Type 2 Diabetes Mellitus.http/:Glycemic Control and Implant Stabilization in Type 2 Diabetes Mellitus.htm

 The interested people can also go through an article on "Implant success in people with type 2
diabetes mellitus with varying glycemic control".JADA 2007;138(3):355-61.http://jada.ada.org.

Diabetes interferes with bone healing and bone formation, but not enough to prevent dental implant healing sufficient to restore your mouth. Having said this, a review of all the studies done found no statistically significant increase in failure rate of dental implants for diabetes patients. One study did show “a significant increase in relative risk of implant failure with diabetes.”

THE PRECAUTIONS WHICH THE DIABETIC PATIENTS WITH DENTAL IMPLANTS SHOULD TAKE ARE

1.One thing to consider if you have d1.iabetes and are considering dental implant treatment is to commit to a good old hygiene program. Uncontrolled diabetes and poor dental hygiene lead to bone loss around teeth especially, but also around implants (though more slowly).

 2.Blood sugar levels need to be appropriate. When blood sugars are high in addition to general health considerations, the oral cavity changes its bacterial flora. Chronic infections in the gum tissue are supported by high glucose levels. So if you are having a period of high sugar readings on your glucometer or a high Hemoglobin A1c you may wish to delay treatment for a few months until blood glucose stabilizes.

If you have Type 1 diabetes you must pay attention to dietary management. If you have decided to go forward with treatment, most often this procedure is done with the patient “asleep” using intravenous sedation. That means you cannot eat after midnight the night before, in what is typically a 7:00 a.m. surgery. The management of your insulin will need to be adjusted and requires coordination with your endocrinologist.