Enhancing dental implant outcomes in type 2 diabetes: Addressing inflammation and risk factors

Table 1 Comparison of key studies investigating dental implant outcomes in type 2 diabetes mellitus

Ref.	Study design and focus	Strengths	Limitations
Li et al[18]	Retrospective cohort. Focus: Early inflammatory trajectory (systemic & GCF), risk factors, and short-term (6 months) PI development in T2DM with conventionally loaded implants	Comprehensive inflammatory profile: Uniquely provides longitudinal data on both systemic (WBC, neutrophils) and local (GCF TNF-α, IL-6) inflammatory markers, bridging clinical observation with potential biological mechanisms. Real-world risk factors: Identifies specific, modifiable behavioral risks (e.g., tooth-brushing duration < 3 minutes) beyond glycemic control, offering highly actionable clinical insights	Retrospective design: Prone to selection bias and unmeasured confounding; precludes causal inference. Short-term follow-up (6 months): Insufficient to assess long-term implant survival and late-onset PI. Single-center study: May limit the generalizability of the findings
Aguilar-Salvatierra et al[19]	Prospective case-control. Focus: Implant survival and peri-implant health (PD, BOP, MBL) of immediately loaded implants in the esthetic zone over 2 years, stratified by HbA1c	Prospective design: Provides higher level of evidence for the specific protocol of immediate loading in T2DM. Longer follow-up (2 years): Allows for assessment of medium-term outcomes and survival rates. Clear HbA1c stratification: Demonstrates a dose-response relationship between glycemic control and MBL/BOP	Focus on a specific protocol: Findings are specific to immediate loading in the anterior maxilla, limiting direct applicability to other sites or loading protocols Limited mechanistic insight: Does not investigate the underlying inflammatory or microbiological profile driving the observed clinical differences
Al Amri et al[20]	Prospective cohort with intervention. Focus: Effect of a structured oral hygiene maintenance program on HbA1c levels and peri-implant parameters around immediately loaded implants over 2 years	Interventional design: Demonstrates a bidirectional relationship where oral hygiene intervention not only improved peri-implant health but also significantly reduced systemic HbA1c levels. Highlights a critical modifiable factor: Empowers a proactive, non-surgical clinical strategy to improve both oral and systemic outcomes	Exclusion of smokers: Limits the generalizability of the results to the broader T2DM population, which often includes smokers. Lacks mechanistic data: Does not explore the inflammatory or microbial changes underlying the clinical improvements

HbA1c: Glycosylated hemoglobin; T2DM: Type 2 diabetes mellitus; GCF: Gingival crevicular fluid.