Diabetes And Dental Implants Pdf
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- PDF: Effects of diabetes on the osseointegration of dental implants
- Dental implants and diabetes mellitus—a systematic review
Diabetes Mellitus is a pandemic metabolic disease prevailing globally and is characterized by chronic hyperglycemia due to absolute or relative deficiency of insulin. It affects most parts of human body including the oral cavity. The review describes the effect of diabetes in the process of osseointegration of implants in oral cavity.
PDF: Effects of diabetes on the osseointegration of dental implants
Diabetes mellitus is a chronic degenerative disease characterized by a set of metabolic disorders and presence of hyperglycemia. When analyzing the effect of diabetes on implants, bone remodeling process alteration and deficient mineralization have been observed: these factors result in poorer bone integration. The aim of the present study was to describe surgical and implant treatment conducted in order to re-establish function and esthetics of a patient's periodontal and general circumstances.
Resulting ridge flange preservation as well as elevation of the maxillary sinus achieved a suitable flange to place implants, by means of a tomographic surgical guide in preparation for further rehabilitation of implant-supported prostheses. As a conclusion we might propose that late diagnosis of aggressive periodontitis can lead to edentulism in young patients, which could be solved with endo-osseous implants..
Diabetes mellitus DM is a systemic disease with many complications which affects the integrity of the human body along its life span. Periodontal disease is one of these complications. It exhibits generalized proximal insertion loss, affecting at least three teeth other than the third molars and incisors, and it presents a poor serum response of antibodies to infectious agents. In many research projects it has been mentioned that DM patients exhibit greater tendency to infection and delayed healing.
This has been associated to poor glycemic control and hyperglycemia, which exert negative effect on bone formation, causing increased resorption, affecting thus bone integration processes. A 25 year old female attended the implantology service.
As personal history the patient reported suffering type 2 Diabetes Mellitus for three years, controlled with metformin. Oral examination revealed a partially edentulous upper jaw as well as generalized pathological migration, with calculi deposits, purulent exudate, evident gingival inflammation as well as grade Ii and III mobility.
Periodontal probing revealed insertion loss greater than 5 mm Figure 1A. Radiographic studies showed severe bone resorption with multiple bone defects Figure 1 B. Based on these facts, the patient received a diagnosis of severe generalized aggressive periodontitis associated to diabetes mellitus, with unfavorable prognosis for all remaining teeth. After analyzing several treatment alternatives, two surgical phases and one prosthetic phase were devised. In the first phase it was decided to conduct multiple extractions with flange preservation and elevation of bilateral maxillary sinus floor.
The second phase was planned once bone graft integration times were fulfilled. This second phase consisted on placement of 12 endo-osseous implants: 6 in the upper jaw, and 6 in the lower jaw. Finally, in the third rehabilitation phase, two fixed implant-supported prostheses were placed. Amoxicillin was chosen as antibiotic 12 g per mouth 1 hour before surgery and mg every eight hours for eight days as well as mouthwash with 0.
Amoxicillin was selected as antibiotic since it is a wide-spectrum drug and acts against pathogen agents streptococci, Gram-positive and Gram-negative anaerobes which most frequently cause post-operative complications after implant placement. Multiple extractions with osteoplasty were conducted, after this procedure, de-mineralized cortical bone allograft and collagen membrane were placed in both arches; the membrane was stabilized with tacks studs.
Healing by first intention was observed in the primary closure of surgical wounds Figure 2A-C. Multiple extractions with ROG use of allograft and collagen membrane. Immediate full prostheses were manufactured to be then placed in a passive and transitory manner. After this, six months were allowed to elapse in order to achieve healing of soft and hard tissues. In a second surgical stage, a bilateral maxillary sinus floor elevation was executed with the lateral window technique first described by Taum 8 and modified by Boyne and James.
During approach to the right side a small perforation was produced Figure 3A-B , therefore, a collagen barrier was placed in order to repair the perforation and protect access to the sinus. A Osteotomy with oval electric hand-piece in order to gain access to the sinus. Sealing of perforation with collagen membrane. Xenograft used within the sinus so as to achieve slow resorption of the biomaterial. After the six month healing period, a diagnostic waxup was performed, since guided bone regeneration and elevation of maxillary sinus floor presented favorable changes for implant planning and placement Figure 4 A-C.
Evolution observed six month after surgery of the flange preservation and maxillary sinus elevation in order to place endoosseous implants. Prosthetic phase was initiated with a diagnostic wax-up DW which was replicated in clear acrylic so as to conduct an esthetic test and decide on rehabilitation type, since the inter-phase between flange and diagnostic wax-up is the most important aspect in problem identification and expectations for the final result of the prosthesis Figure 5.
Wax-up replication for esthetic test. With the esthetic test it could be determined that rehabilitation should be by means of two implantsupported, hybrid, fixed dentures. Once patient and specialists were satisfied with the projected result, a contrast medium was placed into the DW so as to assess with computerized axial tomography CAT the areas of implant placement. Tomographic analysis showed a suitable flange for implant placement.
The silhouette of the teeth of the diagnostic guide was observed Figure 6. The function of this guide was to establish bony tissue characteristics and its direct relation with the type of planned restoration, establishing thus the angle present between residual crest with respect to the final restoration's proposed axial profile.
This is a parameter that can be determined by this kind of device, and thus achieve a tomographic guide. Once the study was completed, data were digitally uploaded in order to be processed with a third dimension program Figure 7. Three D view of diagnostic wax-up in the mandible. Location and placement of implants with respect to maxillary diagnostic wax-up.
The suitable glycemic control exhibited by the patient allowed us to conduct implant placement surgery with the aforementioned pre-operative care. This is to say, a full-thickness flap was executed in the lower jaw. Settling of tomographic surgical guide was assessed, said guide was stabilized with fixation screws.
Burr-use protocol was initiated in order to achieve surgical beds. Six external connection implants were placed, implants were of regular diameter and were strategically distributed in the lateral, first premolar and first molar zones they were placed with a torque greater than 35N.
Flaps were approximated with Vycril suture Figure 8A-B. One month later, the same procedure was executed in the upper arch. A-B Implants strategic positioning. A control panoramic X-ray of the patient was taken in order to assess that implant position corresponded to tomographic surgical planning Figure 9.
Control panoramic X-ray after one month. After review of articles published in the last ten years, it can be reported that survival rate of dental implants in diabetic patients ranged from Ranges of Fiorellini, published a retrospective review of dental implants in 40 diabetic patients: 31 implants failed, out of which 24 This analysis shows a survival rate of Olson, JW et al also conducted a prospective study with 89 type 2 diabetic patients; they studied implants in the lower jaw.
In this study they reported an early failure rate of 2. The fact that most failures occur after the second surgical phase and during the first year of functional load could indicate that micro-vascular affectation is one of the factors playing a role in the failure of diabetic patients implants. Morris HF and Farzard P concluded that, although there is greater failure risk in a diabetic patient, preservation of suitable levels of glucose in the blood along with other measures, improve implant survival percentages in these patients.
Late diagnosis of aggressive periodontitis can lead to edentulism in young patients and thus decrease their quality of life. Suitable hygiene, rigorous glycemic control as well as maintenance program will help decrease the risk of suffering peri-implantitis, which would lead to implant loss. ISSN: X. Implant treatment for a patient with aggressive periodontitis associated to diabetes mellitus. Clinical case report.
Surgical phase. Descargar PDF. Autor para correspondencia. Contenido relaccionado. Rev Odont Mex. Under a Creative Commons license. As a conclusion we might propose that late diagnosis of aggressive periodontitis can lead to edentulism in young patients, which could be solved with endo-osseous implants. Diabetes mellitus. Palabras clave:. Texto completo. Initial clinical photograph. Figure 1A. Initial panoramic X-ray. Figure 1B. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8.
Figure 9. Mellado-Valero, J. Herrera-Ballester, C. Effects of diabetes on the osseointegration o dental implants. EE43 Medline. Development of a classification system for periodontal disease and conditions.
Ann Periodontol, 4 , pp. Periodontitis and diabetes interrelationships: role inflammation. Ann Periodontol, 6 , pp.
Dental implants and diabetes mellitus—a systematic review
Diabetes mellitus is a chronic degenerative disease characterized by a set of metabolic disorders and presence of hyperglycemia. When analyzing the effect of diabetes on implants, bone remodeling process alteration and deficient mineralization have been observed: these factors result in poorer bone integration. The aim of the present study was to describe surgical and implant treatment conducted in order to re-establish function and esthetics of a patient's periodontal and general circumstances. Resulting ridge flange preservation as well as elevation of the maxillary sinus achieved a suitable flange to place implants, by means of a tomographic surgical guide in preparation for further rehabilitation of implant-supported prostheses. As a conclusion we might propose that late diagnosis of aggressive periodontitis can lead to edentulism in young patients, which could be solved with endo-osseous implants.. Diabetes mellitus DM is a systemic disease with many complications which affects the integrity of the human body along its life span. Periodontal disease is one of these complications.
India has the second largest number of people living with diabetes worldwide, after China. As periodontal disease is the sixth major complication of diabetes, these patients are at increased risk for teeth loss. Dental implants have been recognized as an acceptable treatment method for the replacement of missing teeth, but diabetes mellitus is considered a relative contraindication for dental implant therapy. Due to this, these patients may be denied the benefit of dental implants. Hence, this review was done with the aim of reporting findings of various implant studies conducted in diabetic humans so as to improve the understanding of the possibilities for implant therapy in patients with diabetes.
J Oral Implantol 1 August ; 45 4 : — We aimed to conduct an analysis of the systematic reviews SRs in literature about the implant survival rate ISR and marginal bone loss MBL in diabetic and nondiabetic patients. After eliminating repetitions, were reviewed. Finally, 6 SRs were included.
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Dental implant surgery has developed to a widely used procedure for dental rehabilitation and is a secure and predictable procedure. Local and systemic risk factors can result in higher failure rates. Diabetes mellitus is a chronic disease that goes in with hyperglycemia and causes multifarious side effects. Diabetes as a relative contraindication for implant surgery is controversially discussed.
Не поддается. Сьюзан не могла поверить, что это сказал человек, двадцать семь лет работавший с шифрами. - Не поддается, сэр? - с трудом произнесла. - А как же принцип Бергофского. О принципе Бергофского Сьюзан узнала еще в самом начале своей карьеры.
Revista Odontológica Mexicana
Как ее зовут? - Женщина лукаво подмигнула. - Меган, - сказал он печально. - Я полагаю, что у вашей подруги есть и фамилия. Беккер шумно вздохнул. Разумеется. Но мне она неизвестна. - Видите ли, ситуация не столь проста.
- Обычно травматическая капсула не убивает так. Иногда даже, если жертва внушительной комплекции, она не убивает вовсе. - У него было больное сердце, - сказал Фонтейн. Смит поднял брови. - Выходит, выбор оружия был идеальным.
Свою женскую интуицию ты ставишь выше ученых степеней и опыта Джаббы в области антивирусного программирования.
В служебных помещениях ТРАНСТЕКСТА было черно как глубокой ночью. Минуту он наслаждался полной темнотой. Сверху хлестала вода, прямо как во время полночного шторма. Стратмор откинул голову назад, словно давая каплям возможность смыть с него вину.