Closing an Unattractive Gap between Your Two Front Teeth

Do you have uncontrolled diabetes? Either because you are not following your physician's recommendations or because you are still in the process of stabilizing on medications, your blood sugars are all over the map. Diabetes can be frustrating to manage. Due to fluctuating blood sugars, your body takes hits in several areas: the disease weakens your immune system, eyes, kidneys, nerves, and circulation. High blood sugar levels also compromise your oral health by making you vulnerable to periodontal disease, which is an infection of the gums, ligaments, and jawbone. Periodontal disease can lead to premature tooth loss. Unfortunately, this can be a cruel cycle of events, because in the past dentists have hesitated to perform dental implants for people with uncontrolled diabetes, leaving these patients with few options for improvement. However, due to some tenacious researchers, high blood sugar and dental implants are no longer incompatible.

Past problems

Historically, cosmetic dentistry has frowned on dental implants for those people with uncontrolled diabetes. The most critical element of a dental implant is integration of the implant into the bone, and because high blood sugar impedes the integrity of the jawbone, the procedure was deemed unlikely to succeed. Further, a diagnosis of diabetes means

• Slow wound healing

• Increased risk of infection

• Hindrance of the body's inflammatory response

All of these elements combine exponentially into a perfect storm that, understandably, made dentists leery of performing implant surgery on diabetics. Implant failure is not only frustrating to endure but expensive to remedy. Uncontrolled diabetes was deemed a "no-go" for dental implants.

Ground-breaking study

Previous studies of dental implant success in diabetics have been short-term observations of how implants adapted to the bone structure in the mouth. However, a recent study headed by Dr. Thomas M. Oates, Jr., DMD, Ph.D, of the University of Texas did an extended follow up of diabetic implant patients. He and his research team tracked, for one year, the progress of 117 dental patients who had received a total of 234 implants. Of the subjects in the study, 50 did not have diabetes (defined as blood sugar levels below 6% HbA1c), 47 had well-controlled diabetes (below 6 and 8% HbA1c), and 20 had uncontrolled diabetes (8.1% HbA1c and above). The highest blood sugar level recorded in one of the subjects with uncontrolled diabetes was 13.3% HbA1c.

Surprising results

Experts might have expected subjects with the highest blood sugar levels to experience the greatest degree of implant failure. Blind to whether subjects were diabetic or not, Dr. Oates' team assessed subjects at three, six, and 12 months after implant placement and found surprising results:

• Subjects without diabetes had a 93% success rate with their implants

• Subjects with well-controlled diabetes had a 92.6% success rate

• Subjects with uncontrolled diabetes had a 95% success rate--the highest of all three groups

The implant integration time for patients in the last group was significantly longer than for those in the other two categories: their implants took 7.3 months to integrate into the bone rather than the 3.8 month average time for the others. This is perhaps where previous studies have yielded pessimistic results. By not allowing for the increased time needed for implants to settle into the bone and become a permanent placement in the mouth, researchers may have found failure when all that was needed for success was a few more months of healing.

If you are struggling to get your blood sugar under control at the same time that you are experiencing tooth loss, don't assume any longer that you are not a candidate for dental implants. Talk to a specialist in cosmetic dentistry who is familiar with this study and optimistic about your potential for implant success. Diabetes and dental implants are no longer at odds.