The Influence of Diabetes Mellitus and Insulin Therapy on Biomechanical Retention Around Dental Implants: A Study in Rabbits

The Influence of Diabetes Mellitus and Insulin Therapy on Biomechanical Retention Around Dental Implants: A Study in Rabbits
December 2003
Margonar, Rog?Šrio DDS, MS; Sakakura, Celso E. DDS, MS; Holzhausen, Marinella DDS, MS; Pepato, Maria Teresa PhD; C?ĸndia Alba, Rodolfo Jr. DDS; Marcantonio, Elcio Jr. DDS, MS, PhD
Implant Dentistry: Volume 12(4) December 2003 pp 333-339
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Abstract
The oral rehabilitation by dental implants in patients with diabetes remains a controversial issue. The aim of this study was to evaluate the influence of diabetes mellitus and insulin therapy on the bone healing around dental implants using torque removal. Twenty-seven rabbits were randomly divided into 3 groups with 9 animals each: control (C) group, induced diabetic (D) group, and insulin-treated diabetic (ITD) group (10 U/day). After 1 week, one implant was inserted at the tibial metaphysis of the animals. The glucose levels were periodically evaluated through the glucose-oxidase enzymatic method. The animals were killed at 4, 8, and 12 weeks after surgery and the biomechanical test was performed using a torque manometer. Statistically significant differences regarding the removal torque of the implant could not be found at 4 weeks (P = 0.2) among groups. Group C showed statistically higher values than groups D and ITD at the experimental periods of 8 (P = 0.0001 and P = 0.0002, respectively) and 12 weeks (P = 0.0053 and P = 0.001, respectively). There were no statistical differences between D and ITD groups in any of the experimental periods. Diabetes mellitus has negatively influenced the mechanical retention of implants placed at the tibial metaphysis of rabbits. Therapy with insulin did not induce any changes.
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia yielded by abnormalities in the secretion or response of cells to insulin, which is a hormone produced by the beta cells in the pancreatic islets of Langerhans. 1
Diabetic patients represent a significant portion of the population. There are approximately 150 million diabetics in the world, which represents a prevalence of 7.6% among adult individuals between 30 and 68 years of age. The incidence of diabetes mellitus demonstrates no distinction between men and women, and could be higher in the older age groups than in the younger age groups. 2
Considering the prevalence of diabetes mellitus among the world population and the severe periodontal disease and tooth loss in these patients, 3-5 diabetic patients seeking rehabilitative therapies should be regarded as a frequent patient in dental practice. Nevertheless, there is a lack of studies in the literature concerning the effect of such systemic illness and/or its control with insulin on successful osseointegration.
Some experimental studies in animals have demonstrated that diabetes mellitus could negatively interfere with the process of implant osseointegration. 6-12 On the other hand, longitudinal studies carried out in humans have demonstrated that diabetic patients have a survival rate of implants similar to nondiabetic patients. 13,14 Moreover, the influence of insulin therapy on the osseointegration process is still controversial. Fiorellini et al. 15 demonstrated that the percentage of bone-implant contact was significantly lower in the insulin controlled diabetic animals as compared with nondiabetic animals. Conversely, Goodman and Hori 16 showed that insulin therapy was able to restore the normal levels of bone formation and mineralization. Thus, this study aimed to evaluate the influence of diabetes mellitus and insulin therapy on the biomechanical retention of dental implants placed in the tibiae of rabbits.
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