Take Very Good
Care of YouselvesDeuteronomy 4:15


A pilot study for diabetes mellitus with varying glycemic control

Scott Dowell, DDS, MS; Thomas W. Oates, DMD, PhD; Melanie Robinson, DDS, MS
Submitted by Dr. Gedaliah M. Stern

The importance of maintaining stringent glycemic control to minimize some of the most
common diabetic comorbidities is becoming increasingly appreciated.16 Despite these
advances, however, a majority of patients with diabetes still are unable to maintain adequate
glycemic control.17-19 Diabetes mellitus remains a relative contraindication to dental implant
therapy that depends on the patient’s level of glycemic control. As a result, many patients who
have poorly controlled diabetes may be denied the benefits of implant therapy.

Patients with diabetes have increased frequency of periodontitis and tooth loss, which can
lead to compromises in chewing function and diet. The benefits of implant therapy may be
even more relevant to patients with diabetes who are at an increased risk of experiencing tooth loss
and who are critically dependent on managing their diabetes through diet. In fact, the patients
who are most compromised may gain the most from implant therapy. Given the potential for
patients with diabetes to benefit from implant based tooth replacement, we designed this study
to enhance the understanding of both the limitations of and the possibilities for implant therapy
in patients with diabetes by evaluating the impact of glycemic control on implant success and
complications after placement in these patients.

Glycemic control in patients with diabetes is variable. The subjects enrolled in our study were
being followed by their practicing physicians, and their physicians made no alterations in their care
due to their participation in our study. This gave us a reasonably realistic view of the difficulties of
managing diabetes in these subjects. We saw that almost one-half of the subjects changed HbA1c
level groups over the four-month study period, with the greatest changes found in the subjects
with less well-controlled diabetes. This variability reinforces the importance of understanding the
impact of glycemic control on both short- and long-term aspects of implant care. Our findings
also suggest that subjects with relatively low HbA1c levels may have dramatic changes in
glycemic levels with the potential to affect implant success.

Though the results of our preliminary study do not support a detrimental effect
of hyperglycemia on implant success, this remains a possible explanation for the inconsistencies
found in previous studies of implant success in patients with diabetes.

The authors conducted a prospective cohort study to explore the relationship between implant success and glycemic control in patients with type 2 diabetes mellitus.

The HbA1c levels of the subjects ranged from 4.5 to 13.8 percent.
All 50 implants were integrated clinically. The authors identified
three minor complications in three patients having HbA1c levels ranging
from 7.4 to 8.3 percent. None of these complications affected the clinical
management of the cases, and the authors did not identify any adverse

There was no evidence of diminished clinical success or
significant early healing complications associated with implant therapy
based on the glycemic control levels of subjects with type 2 diabetes
Clinical Implications.
These findings support the continued investigation
of the effects of glycemic control on implant therapy toward the
development of therapeutic guidelines that will optimize implant therapy
in patients with diabetes.

Dr. Dowell is in private practice, Abilene, Texas. When this article was written, he was a graduate student in biomedical sciences and funny pictures periodontics, Department of Periodontics, University of Texas Health Science Center at San Antonio.
Dr. Oates is an associate professor, Department of Periodontics, University of Texas Health Science
Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, e-mail “oates@
uthscsa.edu. Address reprint requests to Dr. Oates.
Dr. Robinson is in private practice, Austin, Texas. When this article was written, she was a graduate
student in periodontics, Department of Periodontics, University of Texas Health Science Center at San
The ITI Foundation, Basel, Switzerland, and the San Antonio Area
Foundation provided financial support for this study. Dr. Jim Simpson and the Institute
Straumann AG, Waldenburg, Switzerland, provided the implants used in this study. Dr.
Oates has participated in research sponsored by Institute Straumann AG and presented
A pilot study
Scott Dowell, DDS, MS; Thomas W. Oates, DMD, PhD; Melanie Robinson, DDS, MS
Copyright 2007 American Dental Association. All rights reserved.