Diabetes Mellituslu Hastalarda Dental İmplantların Biyomekaniği

Yıl 2025, Cilt: 1 Sayı: 1, 31 - 43, 24.10.2025

Sema Nur Sevinç Gül , Faezeh Naderlou

Öz

Bu çalışmanın amacı, dental implant başarısında kritik bir rol oynayan osseointegrasyon süreci üzerine diyabetus mellitusun (DM) etkilerini değerlendirmektir. Literatürde yer alan deneysel hayvan çalışmaları ve insanlarda yapılan uzun dönemli klinik araştırmalar incelenerek diyabetin implant stabilitesi, osseointegrasyon ve alveolar kemik iyileşmesi üzerindeki etkileri analiz edilmiştir. Kontrolsüz diyabetik bireylerde periodontal hastalık prevalansı, diş kaybı, oral enfeksiyon insidansı ve yara iyileşmesinde gecikme oranlarının arttığı görülmektedir. Diyabete bağlı osseointegrasyon bozukluklarının temel mekanizmaları arasında hiperglisemiye bağlı kronik inflamasyon, ileri glikasyon son ürünlerinin (AGE) birikimi ve artmış reaktif oksijen türleri (ROS) üretimi öne çıkmaktadır. Bu biyolojik süreçler kemik rezorpsiyonunu artırmakta, kemik oluşumunu azaltmakta ve fibroblast fonksiyonlarını bozarak yara iyileşmesini olumsuz etkilemektedir. Hayvan çalışmalarında diyabetin periodontal rejenerasyon ve osseointegrasyon üzerinde belirgin olumsuz etkileri gösterilmiştir. Ancak insanlarda yapılan uzun dönemli çalışmalarda, diyabetik ve diyabetik olmayan bireyler arasında implant başarısı açısından benzer sonuçlar bildirilmiştir. Diyabet, özellikle kontrolsüz seyrettiğinde osseointegrasyon sürecini olumsuz etkileyebilmekte ve implant başarısını riske atabilmektedir. Ancak mevcut klinik kanıtlar, iyi kontrol edilen diyabetik bireylerde implant tedavisinin başarı oranlarının diyabetik olmayanlarla karşılaştırılabilir olduğunu göstermektedir.

Anahtar Kelimeler

Osseointegrasyon , Diyabet , Dental İmplant , Biyomekanik , Stabilite

Kaynakça

• Abiko, Y., & Selimovic, D. (2010). The mechanism of protracted wound healing on oral mucosa in diabetes. Review. Bosnian Journal of Basic Medical Sciences, 10(3), 186–191.
• Ahmad, P., Estrin, N., Farshidfar, N., Zhang, Y., & Miron, R. J. (2025). Glucagon‐Like Peptide 1 Receptor Agonists (GLP‐1RAs) Improve Periodontal and Peri‐Implant Health in Type 2 Diabetes Mellitus. Journal of Periodontal Research, 60(5), 450-465.
• Al Amri, M. D., Kellesarian, S. V., Al-Kheraif, A. A., Malmstrom, H., Javed, F., & Romanos, G. E. (2016). Effect of oral hygiene maintenance on HbA1c levels and peri-implant parameters around immediately-loaded dental implants placed in type-2 diabetic patients: 2 years follow-up. Clinical oral implants research, 27(11), 1439–1443. https://doi.org/10.1111/clr.12758
• Aldahlawi, S., Nourah, D., & Andreana, S. (2021). Should quality of glycemic control guide dental implant therapy in patients with diabetes? Focus on: Peri-implant diseases. Clinical, cosmetic and investigational dentistry, 149-154.
• Alikhani M, Alikhani Z, Boyd C, et al. Advanced glycation end prod ucts stimulate osteoblast apoptosis via the MAP kinase and cytoso lic apoptotic pathways. Bone. 2007;40(2):345- 353.
• Alrabiah, M., Al‐Aali, K. A., Al‐Sowygh, Z. H., Binmahfooz, A. M., Mokeem, S. A., & Abduljabbar, T. (2018). Association of advanced glycation end products with peri‐implant inflammation in prediabetes and type 2 diabetes mellitus patients. Clinical implant dentistry and related research, 20(4), 535-540.
• Andriankaja OM, Galicia J, Dong G, Xiao W, Alawi F, Graves DT. Gene expression dynamics during diabetic periodontitis. J Dent Res. 2012;91(12):1160- 1165.
• Bai, Y., Wang, S., Zheng, J., Song, S., Zhang, G., Jiao, K., ... & Zhang, S. (2024). Impact of HbA1c levels on the clinical outcomes of ultrahydrophilic, smooth collar implants in patients with type 2 diabetes mellitus. The Journal of Prosthetic Dentistry.
• Baldi, D., Lombardi, T., Colombo, J., Cervino, G., Perinetti, G., Di Lenarda, R., & Stacchi, C. (2018). Correlation between insertion torque and implant stability quotient in tapered implants with knife‐edge thread design. BioMed research international, 2018(1), 7201093.
• Ballantyne, E. Bisphosphonates: Possible modes of action and implications for dental implant treatment. A review of the literature. J. Gen. Pract. 2015, 3, 2. [CrossRef]
• Balshi TJ, Wolfinger GJ. Dental im plants in the diabetic patient: a retrospec tive study. Implant Dentistry. 1999;8:355 359.
• Buranasin P, Mizutani K, Iwasaki K, et al. High glucose- induced ox idative stress impairs proliferation and migration of human gingival fibroblasts. PLoS One. 2018;13(8):e0201855.
• Catalfamo DL, Britten TM, Storch DL, Calderon NL, Sorenson HL, Wallet SM. Hyperglycemia induced and intrinsic alter ations in type 2 diabetes- derived osteoclast function. Oral Dis. 2013;19(3):303- 312. Chrcanovic BR, Albrektsson T, Wennerberg A. Diabetes and oral implant failure: a systematic review. J Dent Res. 2 0 1 4 ; 9 3 ( 9 ) : 8 5 9- 8 6 7.
• Cortizo, A. M., Sedlinsky, C., McCarthy, A. D., Blanco, A., & Schurman, L. (2006). Osteogenic actions of the anti- diabetic drug metformin on osteoblasts in culture. European Journal of Pharmacology, 536(1– 2), 38– 46. https://doi.org/10.1016/j.ejphar.2006.02.030 Cortizo ve ark., 2006.
• Cosola S, Butera A, Hailu Zergaw A, George J, Covani U, Arrighi A, Toti P, Scribante A, Menchini-Fabris GB. Glycemic Control and Implant Stability in Patients with Type II Diabetes: Narrative Review. Healthcare (Basel). 2025 Feb 20;13(5):449. doi: 10.3390/healthcare13050449.
• Dantas, T. A., Neto, J. C., Alves, J. L., Vaz, P. C., & Silva, F. S. (2020). In silico evaluation of the stress fields on the cortical bone surrounding dental implants: Comparing root-analogue and screwed implants. Journal of the Mechanical Behavior of Biomedical Materials, 104, 103667.
• Du Z, Lee RS, Hamlet S, Doan N, Ivanovski S, Xiao Y. Evaluation of the first maxillary molar post- extraction socket as a model for dental implant osseointegration research. Clin Oral Implants Res. 2016;27(12):1469- 1478.
• Erdoğdu, M., Demirel, M. G., Mohammadi, R., & Güntekin, N. (2024). Assessment of the Impact of Bone Quality and Abutment Configuration on the Fatigue Performance of Dental Implant Systems Using Finite Element Analysis (FEA). Journal of Personalized Medicine, 14(10), 1040.
• Ferreira, S.D.; Silva, G.L.M.; Cortelli, J.R.; Costa, J.E.; Costa, F.O. Impact of diabetes on clinical parameters and complications after implant placement: A retrospective study. J. Periodontol. 2006, 77, 915–922.
• Fiorellini JP, Nevins ML, Norkin A, et al. The effect of insulin therapy on os seointegration in a diabetic rat model. Clin Oral Implants Res. 1999;10:362–368.
• Ghiraldini, B., Conte, A., Casarin, R. C., Casati, M. Z., Pimentel, S. P., Cirano, F. R., & Ribeiro, F. V. (2016). Influence of glycemic control on peri‐implant bone healing: 12‐month outcomes of local release of bone‐related factors and implant stabilization in type 2 diabetics. Clinical implant dentistry and related research, 18(4), 801-809.
• Ghorbani, H., Minasyan, A., Ansari, D., Ghorbani, P., Wood, D. A., Yeremyan, R., ... & Minasian, N. (2024). Anti-diabetic therapies on dental implant success in diabetes mellitus: a comprehensive review. Frontiers in Pharmacology, 15, 1506437. Giglio MJ, Giannuzio G, Olmedo D, et al. Histomorphometric study of bone healing around laminar implants in experi mental diabetes. Implant Dentistry. 2000; 9:143–149.
• Golden SH, Peart- Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22(9):1408- 1414.
• Goodman WG, Hori MT. Dimin ished bone formation in experimental dia betes. Relationship to osteoid maturation and mineralization. Diabetes. 1984;33: 825–831.
• Henderson, S.; Ibe, I.; Cahill, S.; Chung, Y.H.; Lee, F.Y. Bone Quality and Fracture-Healing in Type-1 and Type-2 Diabetes Mellitus. J. Bone Jt. Surg. 2019, 101, 1399–1410. [CrossRef] [PubMed]
• Hou M, Lee RSB, Du Z, Hamlet SM, Vaquette C, Ivanovski S. The influence of high- dose systemic zoledronate administration on osseointegration of implants with different surface topography. J Periodontal Res. 2019;54(6):633- 643.
• Hu X- F, Wang L, Lu Y- Z, et al. Adiponectin improves the osteointe-gration of titanium implant under diabetic conditions by reversing mitochondrial dysfunction via the AMPK pathway in vivo and in vitro. Acta Biomater. 2017;61:233- 248.
• Inouye, K. A. S., Bisch, F. C., Elsalanty, M. E., Zakhary, I., Khashaba, R. M., & Borke, J. L. (2014). Effect of metformin on periimplant wound healing in a rat model of type 2 diabetes. Implant dentistry, 23(3), 319-327.
• James, Y., Butt, W. M. M., Shahid, H., Ahmad, S., Imran, M. T. B., & Anthony, N. (2024). Success Rates of Dental Implants in Patients With Diabetes: A Systematic Review. Cureus, 16(12).
• Javed, F., & Romanos, G. E. (2019). Chronic hyperglycemia as a risk factor in implant therapy. Periodontology 2000, 81(1), 57-63.
• Jeffcoat, M. The association between osteoporosis and oral bone loss. J. Periodontol. 2005, 76, 2125–2132. [CrossRef] [PubMed].
• Jiang X, Zhu Y, Liu Z, Tian Z, Zhu S. Association between diabetes and dental implant complications: a systematic review and meta- analysis. Acta Odontol Scand. 2021;79(1):9- 18.
• Jiao, L. V., Hong- Chen, L., Ling- Ling, E., & Dong- Sheng, W. (2008). Effects of metformin on the development of osteoblasts from rat mandible. Chinese Journal of Geriatric Dentistry, 6(1), 47– 49.Jiao ve ark., 2008.
• Kalaitzoglou, E., Fowlkes, J. L., Popescu, I., & Thrailkill, K. M. (2019). Diabetes pharmacotherapy and effects on the musculoskeletal system. Diabetes/metabolism research and reviews, 35(2), e3100.
• Kanazawa, I., Yamaguchi, T., Yano, S., Yamauchi, M., & Sugimoto, T. (2008). Metformin enhances the differentiation and mineralization of osteoblastic MC3T3- E1 cells via AMP kinase activation as well as eNOS and BMP- 2 expression. Biochemical and Biophysical Research Communications, 375(3), 414– 419. https://doi.org/10.1016/j. bbrc.2008.08.034 Kanazawa ve ark., 2008.
• Khader, Y. S., Dauod, A. S., El-Qaderi, S. S., Alkafajei, A., & Batayha, W. Q. (2006). Periodontal status of diabetics compared with nondiabetics: A meta-analysis. Journal of Diabetes and Its Complications, https://doi.org/10.1016/j.jdiacomp.2005.05.006.
• Kido D, Mizutani K, Takeda K, et al. Impact of diabetes on gingival wound healing via oxidative stress. PLoS One. 2017;12(12):e0189601.
• Lee, J.S.; Shin, H.K.; Yun, J.H.; Lee, J.K.; Han, K.J. Association of diabetes mellitus with failure of dental implants: A systematic review and meta-analysis. Clin. Oral Implant. Res. 2014, 25, 20–28.
• Margonar, R., Sakakura, C. E., Holzhausen, M., Pepato, M. T., Alba Jr, R. C., & Marcantonio Jr, E. (2003). The influence of diabetes mellitus and insulin therapy on biomechanical retention around dental implants: a study in rabbits. Implant dentistry, 12(4), 333-339.
• McCracken M, Lemons JE, Ranemtulla F, et al. Bone response to tita nium alloy implants placed in diabetic rats. Int J Oral Maxillofac Implants. 2000;15: 345–354. 10.
• Mody N, Parhami F, Sarafian TA, Demer LL. Oxidative stress mod ulates osteoblastic differentiation of vascular and bone cells. Free Radic Biol Med. 2001;31(4):509- 519.
• Moraschini V, Barboza ES, Peixoto GA. The impact of diabetes on dental implant failure: a systematic review and meta- analysis. Int J Oral Maxillofac Surg. 2016;45(10):1237- 1245.
• Mouraret S, Hunter DJ, Bardet C, Brunski JB, Bouchard P, Helms JA. A pre- clinical murine model of oral implant osseointegration. Bone. 2014;58:177- 184.
• Nourah, D., Aldahlawi, S., & Andreana, S. (2022). Should the quality of glycemic control guide dental implant therapy in patients with diabetes? Focus on implant survival. Current Diabetes Reviews, 18(4), 8-15.
• Oates Jr, T. W., Galloway, P., Alexander, P., Green, A. V., Huynh-Ba, G., Feine, J., & McMahan, C. A. (2014). The effects of elevated hemoglobin A1c in patients with type 2 diabetes mellitus on dental implants. The Journal of the American Dental Association, 145(12), 1218-1226.
• Pacios S, Andriankaja O, Kang J, et al. Bacterial infection increases periodontal bone loss in diabetic rats through enhanced apoptosis. Am J Pathol. 2013;183(6):1928- 1935.
• Pacios S, Kang J, Galicia J, et al. Diabetes aggravates periodonti tis by limiting repair through enhanced inflammation. FASEB J. 2012;26(4):1423- 1430.
• Pandey, C., Rokaya, D., & Bhattarai, B. P. (2022). Contemporary concepts in osseointegration of dental implants: a review. BioMed research international, 2022(1), 6170452.
• Park, J., Park, S., Kang, I., & Noh, G. (2022). Biomechanical effects of bone quality and design features in dental implants in long-term bone stability. Journal of Computational Design and Engineering, 9(5), 1538-1548. Materials, 2025; Biomedicines, 2025.
• Rokaya, D., Srimaneepong, V., Wisitrasameewon, W., Humagain, M., & Thunyakitpisal, P. (2020). Peri-implantitis update: risk indicators, diagnosis, and treatment. European journal of dentistry, 14(04), 672-682.
• Sachelarie, L., Scrobota, I., Cioara, F., Ghitea, T. C., Stefanescu, C. L., Todor, L., & Potra Cicalau, G. I. (2025). The influence of osteoporosis and diabetes on dental implant stability: a pilot study. Medicina, 61(1), 74. Saito N, Mikami R, Mizutani K, Takeda K, Kominato H, Kido D, Ikeda Y, Buranasin P, Nakagawa K, Takemura S, Ueno T, Hosaka K, Hanawa T, Shinomura T, Iwata T. Impaired dental implant osseointegration in rat with streptozotocin-induced diabetes. J Periodontal Res. 2022 Apr;57(2):412-424.
• Serrão, C. R., Bastos, M. F., Cruz, D. F., de Souza Malta, F., Vallim, P. C., & Duarte, P. M. (2017). Role of metformin in reversing the negative impact of hyperglycemia on bone healing around implants inserted in type 2 diabetic rats. The International Journal of Oral & Maxillofacial Implants, 32(3), 547– 554. https://doi.org/10.11607/ jomi.5754. Shen, W. R., Kimura, K., Ishida, M., Sugisawa, H., Kishikawa, A., Shima, K., ... & Kitaura, H. (2018). The glucagon‐like Peptide‐1 receptor agonist Exendin‐4 inhibits lipopolysaccharide‐induced osteoclast formation and bone resorption via inhibition of TNF‐α expression in macrophages. Journal of immunology research, 2018(1), 5783639.
• Shernoff AF, Colwell JA, Bingham SF. Implant for type II diabetic patients: in terim report. Implant Dentistry. 1994;3: 183–185.
• Souto- Maior JR, Pellizzer EP, de Luna Gomes JM, et al. Influence of diabetes on the survival rate and marginal bone loss of den tal implants: an overview of systematic reviews. J Oral Implantol. 2019;45(4):334- 340. Takeda K, Mizutani K, Matsuura T, et al. Periodontal regener ative effect of enamel matrix derivative in diabetes. PLoS One. 2018;13(11):e0207201.
• Takeshita F, Murai K, Iyama S, et al. Uncontrolled diabetes hinders bone for mation around titanium implants in rat tib iae. A light and fluorescence microscopy, and image processing study. J Periodon tol. 1998;69:314–320 Tsolaki, I.N.; Madianos, P.N.; Vrotsos, J.A. Outcomes of dental implants in osteoporotic patients: A literature review. J. Prosthodont. 2009, 18, 309–323. [CrossRef] [PubMed]
• Wagner, J., Spille, J. H., Wiltfang, J., & Naujokat, H. (2022). Systematic review on diabetes mellitus and dental implants: an update. International journal of implant dentistry, 8(1), 1.
• Wang, R., Na, H., Cheng, S., Zheng, Y., Yao, J., Bian, Y., & Gu, Y. (2023). Effects of glucagon like peptide 1 receptor agonists on fracture healing in a rat osteoporotic model. Experimental and Therapeutic Medicine, 26(3), 412.
• Warram, J. H., Martin, B. C., Krolewski, A. S., Soeldner, J. S., & Kahn, C. R. (1990). Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Annals of internal medicine, 113(12), 909-915.
• Weinstein, T., Clauser, T., Del Fabbro, M., Deflorian, M., Parenti, A., Taschieri, S., ... & Francetti, L. (2020). Prevalence of peri-implantitis: a multi-centered cross-sectional study on 248 patients. Dentistry journal, 8(3), 80. Wu,Z.;Yan, X.; Sun, Y.; Zhu, X.; Liu, Z.; Li, X. Salivary biomarkers in dental implantology: A systematic review. Int. J. Oral Sci. 2020, 12, 17.
• Yao, D., & Brownlee, M. (2010). Hyperglycemia-induced reactive oxygen species increase expression of the receptor for advanced glycation end products (RAGE) and RAGE ligands. Diabetes, 59(1), 249-255. Yu SH, Hao J, Fretwurst T, et al. Sclerostin- neutralizing antibody enhances bone regeneration around oral implants. Tissue Eng Part A. 2018;24(21– 22):1672- 1679.
• Zhen, D., Chen, Y., & Tang, X. (2010). Metformin reverses the deleterious effects of high glucose on osteoblast function. Journal of Diabetes and Its Complications, 24(5), 334– 344. https://doi.org/10.1016/j.jdiac omp.2009.05.002.Zhen ve ark., 2010