Systematic review on diabetes mellitus and dental implants: an update

Purpose Dental implant surgery was developed to be the most suitable and comfortable instrument for dental and oral rehabilitation in the past decades, but with increasing numbers of inserted implants, complications are becoming more common. Diabetes mellitus as well as prediabetic conditions represent a common and increasing health problem (International Diabetes Federation in IDF Diabetes Atlas, International Diabetes Federation, Brussels, 2019) with extensive harmful effects on the entire organism [(Abiko and Selimovic in Bosnian J Basic Med Sci 10:186–191, 2010), (Khader et al., in J Diabetes Complicat 20:59–68, 2006, 10.1016/j.jdiacomp.2005.05.006)]. Hence, this study aimed to give an update on current literature on effects of prediabetes and diabetes mellitus on dental implant success. Methods A systematic literature research based on the PRISMA statement was conducted to answer the PICO question “Do diabetic patients with dental implants have a higher complication rate in comparison to healthy controls?”. We included 40 clinical studies and 16 publications of aggregated literature in this systematic review. Results We conclude that patients with poorly controlled diabetes mellitus suffer more often from peri-implantitis, especially in the post-implantation time. Moreover, these patients show higher implant loss rates than healthy individuals in long term. Whereas, under controlled conditions success rates are similar. Perioperative anti-infective therapy, such as the supportive administration of antibiotics and chlorhexidine, is the standard nowadays as it seems to improve implant success. Only few studies regarding dental implants in patients with prediabetic conditions are available, indicating a possible negative effect on developing peri-implant diseases but no influence on implant survival. Conclusion Dental implant procedures represent a safe way of oral rehabilitation in patients with prediabetes or diabetes mellitus, as long as appropriate precautions can be adhered to. Accordingly, under controlled conditions there is still no contraindication for dental implant surgery in patients with diabetes mellitus or prediabetic conditions.

What is the impact of drug therapy with antiresorptive agents on the success of dental implants? a literature review

Objective: To review the current literature and provide the latest information on anti-resorptive agent-induced osteonecrosis of the jaw (ARONJ), including our basic and clinical research findings, as well as discuss the risks of developing osteonecrosis in patients undergoing dental implant surgery in use of anti-resorptive drugs (ARDs). Methods: A literature review was performed using articles published in indexed journals based on Pubmed, Web of Science, Embase and Scopus databases. Results: Our results show that the placement of dental implants in patients treated with ARDs should be carefully evaluated, these patients are not free from complications and, therefore, the risk assessment should be done individually, as one of the most serious complications, although rare, is the ARONJ. Conclusion: Thus, all patients treated with this type of drug should be informed about the risk of implant loss or the possibility of osteonecrosis, being necessary to inform about the increased risk also patients who already have osteointegrated implants and will start therapy with bisphosphonates (BPT). And, in addition, establishing a relationship and collaboration between doctor, dentist and patient is essential for the good prognosis of these cases.

Use of Phentolamine Mesylate in Implant Surgery: Analysis of Adverse Effects and Haemodynamic Changes

The clinical application of phentolamine mesylate (PM) as an anaesthetic reversal agent has been documented in the paediatric population and in conservative dentistry, but no studies have been conducted regarding dental implant surgery. A prospective randomised study was conducted on 60 patients eligible for mandibular implant treatment, randomly divided between a control group (CG) and an experimental group (EG), to whom PM was administered. Haemodynamic changes, adverse effects and patient satisfaction were assessed. No statistically significant differences in haemodynamic changes and postoperative pain were found between CG and EG (p < 0.05), except for systolic blood pressure (SBP), which increased slightly in EG, without posing a risk to patients. There were no differences in the occurrence of adverse effects between the two groups, except for greater difficulty in chewing and biting (p < 0.05) in CG and greater pain in the injection area (p = 0.043) in EG. Among EG patients, 83.3% reported that they would request PM again for future dental treatment. The use of PM offers an alternative to implant surgery, thereby increasing patients’ quality of life without increasing the risks.

Dental implants and risk of bleeding in patients on oral anticoagulants: a systematic review and meta-analysis

Background Dental implant placement is safe and predictable, yet optimal management of anticoagulated patients remains controversial. Whilst cessation of anticoagulation pre-operatively should decrease risks of bleeding, risk of thrombosis increases. We aim to define risk of bleeding in patients on oral anticoagulation who are undergoing dental implant placement, in order to establish best management. Methods This systematic review is registered with the National Institute for Health Research (NIHR) PROSPERO database (Registration No: CRD42021233929). We performed a systematic review as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Studies were identified using an agreed search strategy within the OVID Gateway (this included Pubmed, MEDLINE, Cochrane Collaborative). Studies assessing bleeding complications in patients who were undergoing dental implant placement were selected. The primary outcome was bleeding events in anticoagulated patients undergoing dental implant placement. Secondary outcomes included any complication requiring further intervention. Results We identified 182 studies through screening, and after review of titles and abstracts reduced this to 8 studies. In these studies, 1467 participants received at least 2366 implants. Studies were analysed for quality using the ROBINS-I risk of bias tool. Four studies were retrospective case reviews, and four were prospective reviews, three of which also blinded the operator to anticoagulation status. There was significant heterogeneity between the included studies. Meta-analysis showed an increased risk of bleeding (RR, 2.30; 95% CI, 1.25-4.24 p = 0.37 I = 7%) when implants were placed in the presence of anticoagulation however these were not clinically significant haemorrhagic events. Conclusion The continuation of anticoagulants peri-operatively during dental implant surgery does increase the risk of clinically non-significant peri- and post-operative bleeding. Dental implant surgery encompasses a broad spectrum of procedures ranging from minor to more invasive surgery with simple local haemostatic measures mitigating the risk of bleeding. The decision to discontinue anticoagulants prior to dental implant surgery must consider patient and surgical factors with the clinician undertaking a risk-balance assessment.

Morphological Aspects of the Maxillary Sinus

The development of modern surgical methods and techniques for treatment of the diseases of the paranasal sinuses and the edentulous ridge of the maxilla requires detailed knowledge of the anatomy, physiology and pathology of the maxillary sinus. The sinus dimensions and volume, thickness of the mucosa, height of the inferior wall and presence of septa and root prominence are important indicators for the pneumatization of the maxillary sinus and have essential role by performing sino-nasal and dental implant surgery. The preliminary assessment of some morphological aspects of the maxillary sinus is essential for the proper diagnosis and treatment of a number of diseases in maxillofacial region, including treatment of the chronic rhinosinusitis and the edentulous ridges of the distal maxilla.

Fluctuation of salivary alpha-amylase activity levels and vital signs during dental implant surgery

Background Salivary alpha-amylase (sAA) activity level is thought to be an indicator of mental stress. However, the relationship between sAA activity levels and mental stress in patients during dental implant treatment has not been studied. In the present study, we aimed to examine the correlation between sAA activity levels and changes in patients’ vital signs during dental implant surgery. Results Levels of sAA activity were higher after surgery when compared to before-surgery measurements. A significant positive correlation was found between sAA activity and heart rate (HR) (rs=0.434, p=0.007) as well as a positive correlation with oxygen level (rs=0.392, p=0.016). Conclusion Levels of sAA activity tended to increase after the surgical procedures, as did patients’ stress levels. SpO2 and sAA activity levels were inversely correlated. There was a positive significant correlation between HR and sAA activity, though there was no correlation between blood pressure and sAA activity levels. Salivary alpha-amylase may be a valuable indicator of stress and anxiety in dental patients undergoing dental implant surgery.