A SYSTEMATIC REVIEW AND META-ANALYSIS OF DENTAL IMPLANTS IN PATIENTS WITH DIABETES MELLITUS

Аннотация

This review aimed to assess the effects of diabetes mellitus on dental implant failure rates and marginal bone loss (MBL). An electronic search was conducted across three databases, supplemented by a manual search of relevant journals. Meta-analyses and meta- regressions were performed to examine how the odds ratio (OR) and MBL were influenced by follow-up duration. A total of 89 studies were included in the review, encompassing 5,510 implants in diabetic patients and 62,780 in non-diabetic patients. Pairwise meta-analysis revealed a higher failure risk for implants in diabetic patients compared to non-diabetic patients (OR 1.777, p < 0.001). Implant failure was significantly more frequent in type 1 diabetes patients than in type 2 (OR 4.477, p = 0.032). Statistically significant differences in implant failure rates were observed between the maxilla and mandible, with significance only in the maxilla. The mean difference (MD) in MBL between diabetic and non-diabetic patients was 0.776 mm (p = 0.027), with an estimated MBL MD increase of 0.032 mm per additional month of follow-up (p < 0.001). Additionally, there was an estimated OR decrease of 0.007 for each extra month of follow-up (p = 0.048). In conclusion, dental implants in diabetic patients showed a 77.7% higher failure risk compared to those in non-diabetic patients. Keywords: dental implant, implant failure, marginal bone loss, diabetes mellitus, systematic review, meta-analysis, meta-regression. 1. Introduction Diabetes mellitus encompasses a group of metabolic disorders marked by elevated blood glucose levels, which arise from problems in insulin production (when the pancreas does not release enough insulin), insulin function (when the body cannot effectively utilize the insulin produced), or both. The most common form, type 2 diabetes, represents the vast majority of cases worldwide, and its prevalence has been rapidly increasing, with predictions indicating a significant rise in affected adults over the coming years. This highlights the critical importance of understanding the impacts of diabetes. Chronic high blood sugar levels in diabetes often lead to damage, dysfunction, or even failure of various tissues and organs, resulting in significant health burdens. Additionally, the duration of diabetes itself can influence a patient’s clinical and functional condition, regardless of glycemic control or age. These complications stem from several adverse effects, such as delayed wound healing, microvascular issues, reduced infection response, and compromised bone metabolism and strength. For individuals who develop type 2 diabetes at a young age, the risk of these complications steadily increases over time, affecting many by early adulthood. Blood sugar levels, or glycemia, play an important role in these outcomes, as research has shown a connection between glycemic control and the development of complications affecting both small and large blood vessels. Intensive glycemic control in diabetic patients can delay the onset and progression of various complications linked to microvascular damage, 30 YOSH OLIMLAR ILMIY-AMALIY KONFERENSIYASI in-academy.uz/index.php/yo although this benefit tends to diminish once complications have already manifested. Diabetic patients are considered to have controlled diabetes when their blood glucose levels are kept close to normal, typically indicated by the HbA1c test, which measures the percentage of glycated hemoglobin. Patients with HbA1c levels up to a certain threshold are considered well-controlled. The negative impact of diabetes on bone metabolism has led to concerns about the long- term success of dental implants in diabetic patients. A prior systematic review on this topic has provided some insight, suggesting that diabetes may indeed affect implant failure rates compared to non-diabetic patients. However, that earlier review included only a limited number of studies. Therefore, the goal of this current systematic review is to expand on previous findings, comparing implant failure rates and marginal bone loss between diabetic and non-diabetic patients on a larger scale. 2. Materials and Methods This study adhered to the guidelines set forth by the PRISMA 2020 Statement and was registered in the PROSPERO database (CRD42021240670). 2.1. Objective The aim of this study was to evaluate the null hypothesis that no difference exists in implant failure rates and marginal bone loss (MBL) following the placement of dental implants in diabetic patients compared to non-diabetic patients, contrasting this with the alternative hypothesis that a difference does exist. This investigation was conducted through a systematic review of the literature. To guide the study, the PICO framework (participants, interventions, comparisons, outcomes) was used to formulate the focused question: Among partially and fully edentulous patients (participants) receiving dental implants (intervention), is there a difference in implant failure ra