Effects of diabetes/hyperglycemia on peri‐implant biomarkers and clinical and radiographic outcomes in patients with dental implant restorations: A systematic review and meta‐analysis
Xiaolei Lv, Lilin Zou, Xiaomeng Zhang, Xin Zhang, Hongchang Lai, Junyu Shi
Abstract
OBJECTIVE: The objective of this study is to systematically analyze the effects of diabetes mellitus/hyperglycemia (DM/HG) on peri-implant biomarkers and clinical and radiographic outcomes in patients undergoing implant treatment. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched up to March 2022. Studies reporting on peri-implant biomarkers, and clinical and radiographic outcomes in patients with different glycemic status levels (HbA1c) were included. Several analyses were conducted, such as meta-analysis, sensitivity analysis, dose-response meta-analysis (DRMA), and robust error meta-regression (REMR). RESULTS: A total of 10 studies and 634 participants were included for analysis, with a maximum follow-up of six years in function. The level of advanced glycation end products (AGEs) in peri-implant crevicular fluid (PICF) was significantly higher in the DM/HG group than in the healthy group (p < .01). Subgroup analyses showed that a set of negative regulators of bone metabolism (including IL-6, TNF-α, IL-8, and RANKL) were significantly higher in the DM/HG group (p = .01). Implant survival rate (100%) was not compromised in patients with an HbA1c level less than 10%. Outcomes of implant stability quotient (ISQ) values, bleeding on probing rate (BOP%), probing depth (PD), and marginal bone loss (MBL) in the DM/HG group were significantly worse than those in the healthy group (p = .04, <0.01, 0.01, <0.01, respectively). DRMA results showed AGE accumulation in PICF, PD, and MBL worsened in a dose-response dependent manner with elevated HbA1c levels (<6%, 6-8%, >8%; p = .04, 0.02, <0.01, respectively). CONCLUSIONS: DM/HG can upregulate negative regulators of bone metabolism and compromise peri-implant health. In addition, there are dose-response relationships between HbA1c levels and AGE accumulation in PICF, PD, and MBL.