Diabetes and bone augmentation

We identified two prospective studies that evaluated “advanced” implant surgery covering sinus lift procedure and guided bone regeneration.

The study of Erdogan consists of type II diabetics moderately and well-controlled (HbA1c 6–7.5 %) with a mean duration of disease of 7.5 years and a healthy control group. Augmentation of the maxilla was performed by guided bone regeneration with autologous bone from the mandibular ramus harvested by bone scrapers, a synthetic bone substitute, and collagen membrane. The result after 1 year is that patients with HbA1c levels <7.5 % may undergo staged guided bone regeneration securely. The other study consisted of a larger group of type II diabetic patients and healthy control which were treated with simple or advanced implant therapy. The authors conclude that well- to fairly well-controlled diabetic patients with a mean HbA1c of 7.2 % had the same overall survival rate as controls in conventional and advanced implant therapy. No difference was seen when looking at bone resorption.

Influence of quality of glycemic control

When looking at the question, if diabetes is a risk factor for dental implants, it is not sufficient to decide having diabetes or not. The greater the impact of diabetes, the worse the patient handles with glycemic control. In international studies, the percentage of glycosylated hemoglobin is an indicator for glycemic levels from previous 6–8 weeks. Unfortunately, many studies do not provide data of HbA1c. Some authors call their patient “under well control” or “poorly controlled,” without representing any definition. Our search identified seven studies with a clear definition of different qualities of glycemic control by HbA1c.

Three defined HbA1c 6–8 % as good, 8–10 % as moderately, and >10 % as poorly controlled. Two studies called HbA1c <8 % better and >8 % poorly controlled and another <7 % well, 7–9 % moderately, and >9 % poorly controlled.