Analysis of inflammatory response and its factors after dental implant surgery in patients with type 2 diabetes

Abstract

BACKGROUND

Dental implants are widely used to replace missing teeth. Currently, clinicians assess osseointegration success by measuring the implant’s stability within the bone and monitoring the marginal tissue height. Diabetes, especially type 2 diabetes mellitus (T2DM), has been reported to impair implant healing, drastically reducing implant success rates.

AIM

To analyze the high-risk factors for inflammatory response and prognosis after dental implantation in patients with T2DM, and provide strong evidence for reducing the incidence of postimplant peri-implantitis (PI).

METHODS

We performed a retrospective review of 146 patients with T2DM who had dental implants placed at Tianjin Fifth Central Hospital, between September 2021 and September 2023, which was regarded as the observation group. Moreover, 60 age- and gender-matched individuals with normal blood glucose levels served as the control group. The general information, postoperative periodontal indices, and levels of inflammatory factors were comprehensively analyzed and compared. Furthermore, the incidence of postimplant PI was counted, and multivariate logistic regression was used to identify the determinants of postimplant PI.

RESULTS

In terms of the periodontal indices, the probing depth, modified sulcus bleeding index, and marginal bone loss in the observation cohorts began to increase significantly at 6 months and 3 months, respectively, after the completion of dental implant restoration. The T2DM cases demonstrated significantly elevated counts of leukocytes, lymphocytes, and neutrophils compared to the controls at 24 hours postoperatively. Moreover, the TNF-α, IL-1β, and IL-6 concentrations started to increase significantly in the gingival crevicular fluid 3 months after the completion of dental implant restoration in both cohorts, with the observation group exhibiting higher levels than the controls at each time point. 63 out of the 146 cases developed PI. Multivariate logistic regression analysis indicated that high glycosylated hemoglobin levels, smoking, daily tooth-brushing frequency of less than once, and the anterior tooth as the implant site independently contributed to postimplant PI in T2DM cases, while a tooth-brushing duration of ≥ 3 minutes was a protective factor.

CONCLUSION

Patients with T2DM are at risk of developing PI following dental implantation. Clinically, it is necessary to enhance the identification of risk factors for postimplant PI, improve risk prediction, prevention, and control, and formulate targeted intervention countermeasures to reduce the occurrence of postimplant PI.

Keywords: Type 2 diabetes mellitus; Dental implants; Inflammatory response; Factor analysis; Periodontal prognosis

Core Tip: Currently, oral rehabilitation is gradually achieved by placing dental implants. Despite generally good success rates for these implants, research shows that patients with diabetes, especially type 2 diabetes mellitus (T2DM), experience more failures. Therefore, the identification of patients at elevated risk for peri-implant inflammatory complications [e.g., peri-implantitis (PI) and peri-implant mucositis] should be prioritized. This study focuses on analyzing the inflammatory response and contributors to postimplant PI in patients with T2DM, providing evidence for reducing the incidence of PI after dental implant surgery.