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Investigating Implants

Diabetics take longer to heal – but how does it affect their dental care?

October 2002

by Aileen Salinas

With an estimated 17 million people living with diabetes, Americans have become all too familiar with its effects on people. Its commonly known complications include increased risk for heart disease, stroke, kidney failure, foot lesions and eye disease.

"We have good evidence that suggests a lot of organs are affected by diabetes," said Thomas Oates, D.D.S., assistant professor of periodontics. "And we know healing in general, especially dermal or skin wound healing, is affected, but we donít know a lot about healing of bone."

Without understanding how diabetes influences bone metabolism, oral health professionals do not know how to alter treatment for patients with the disease, especially patients who have lost teeth. "Weíre in the business of saving and replacing teeth," Dr. Oates said. "If we can offer patients dental implants, then we can offer the best treatment we can provide." Although doctors continue to treat diabetic patients with implants, they worry how well the patients will recover from the required implant surgery.

Determined to find answers, second-year periodontal resident Melanie Robinson, D.D.S., began a study last summer comparing the surgical healing time of 10 patients with diabetes to that of 10 patients without diabetes. The results will lay the groundwork for a larger study, one that could contribute knowledge beyond dentistry by providing data on diabetes' role in osteoporosis.

To place implants, doctors drill a small hole into the jawbone and insert a titanium screw. Before a crown can be placed on top of the implant, the surrounding bone must integrate with the implant. "Teeth are valuable for nutritional and overall health reasons, so placing implants in patients with diabetes is important," Dr. Robinson said.

Doctors use the Osstell™ in a number of procedures, but this is the first time dentists used the tiny, non-invasive device to study bone healing. By tracking the frequencies sent out by the Osstell™ transducer, Health Science Center dentists measure the rate of bone healing in patients with diabetes.

  The Osstell transducer
As teeth are lost, the jawbone deteriorates. Implants help stop bone loss by imitating a patientís own teeth and restoring chewing function. More stable than removable dentures, implants also are just as strong as human teeth.

Through her work, Dr. Robinson is establishing procedures for dental treatment of patients with diabetes. She and Dr. Oates, her faculty adviser, hope to begin understanding how diabetes alters bone metabolism in the whole body. "We might be able to see how osteoporosis is a problem for some of these patients," Dr. Oates said.

Using a small, non-invasive device that sends a frequency to the jawbone causing it to vibrate, Drs. Robinson and Oates measure how well the bone is holding on to the implant. "Over time, we can tell if healing is modified in patients with diabetes," Dr. Oates said.

"We know soft tissue in the mouth can have altered wound healing, especially if people donít manage diabetes well," Dr. Robinson said. "It takes longer for diabetic patients to heal from a surgical procedure on soft tissue in the mouth. So we need to understand how well bone will heal."

Normal bone healing for healthy patients seems to plateau after six weeks. "It seems as though patients with well- to moderately well-controlled diabetes are going eight to 12 weeks," Dr. Robinson said.

Today patients are receiving crowns much sooner after surgery. Dentists used to wait four to six months following the placement of an implant before building a tooth on top. These days, implant companies are pushing toward six to eight weeks. "While the shorter time can be convenient for most patients, patients with diabetes might run into complications," Dr. Oates said. "But with no prior knowledge in this area, we donít know exactly where to draw the line."

Until now, most of the literature regarding Type 2 diabetesí role in bone metabolism has been inconclusive. "We know diabetes compromises many of the bodyís organs and biological processes, so we have to consider the possibility that bone metabolism also is affected," Dr. Oates said.

Dr. Robinsonís research could not come at a better time. Approximately 1 million new cases of diabetes are diagnosed each year. Furthermore, people with diabetes often are twice as likely as people without diabetes to develop periodontal disease, which can lead to tooth loss. Another concern is the increased risk for the elderly to develop diabetes. "As patients get older, Type 2 diabetes and tooth loss becomes more prevalent," Dr. Oates said.

Dr. Robinson received $40,000 from the ITI Foundation for her study.


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