A critical review of diabetes, glycemic control, and dental implant therapy.

OBJECTIVES: To systematically examine the evidence guiding the use of implant therapy relative to glycemic control for patients with diabetes and to consider the potential for both implant therapy to support diabetes management and hyperglycemia to compromise implant integration. MATERIAL AND METHODS: A systematic approach was used to identify and review clinical investigations directly assessing implant survival or failure for patients with diabetes. A MEDLINE (PubMED) database search identified potential articles for inclusion using the search strategy: (dental implants OR oral implants) AND (diabetes OR diabetic). Inclusion in this review required longitudinal assessments including at least 10 patients, with included articles assessed relative to documentation of glycemic status for patients. RESULTS: Although the initial search identified 129 publications, this was reduced to 16, for inclusion. Reported implant failure rates for diabetic patients ranged from 0% to 14.3%. The identification and reporting of glycemic control was insufficient or lacking in 13 of the 16 studies with 11 of these enrolling only patients deemed as having acceptable glycemic control, limiting interpretation of findings relative to glycemic control. Three of the 16 studies having interpretable information on glycemic control failed to demonstrate a significant relationship between glycemic control and implant failure, with failure rates ranging from 0% to 2.9%. CONCLUSIONS: Clinical evidence is lacking for the association of glycemic control with implant failure while support is emerging for implant therapy in diabetes patients with appropriate accommodations for delays in implant integration based on glycemic control. The role for implants to improve oral function in diabetes management and the effects of hyperglycemia on implant integration remain to be determined.

Conventional SLA and chemically modified SLA implants in patients with poorly controlled type 2 diabetes mellitus--a randomized controlled trial.

OBJECTIVE: The objective of this study was to evaluate the potential for a chemically modified Sand blasted, Large grit, Acid etched (SLA) surface, compared with a conventional SLA surface, to enhance implant healing and integration in poorly controlled diabetic patients, a group previously demonstrated to have compromises and delays in implant stabilization during the metabolically active healing period following implant placement. MATERIALS AND METHODS: The study enrolled 24 patients with type 2 diabetes, baseline HbA1c levels between 7.5-11.4%, and a minimum of two posterior mandibular tooth sites at least 4 months following extraction and appropriate for implant placement. Each patient, at a randomly selected site, received an implant with the conventional SLA surface; at the second site, the patient received an implant with the chemically modified SLA (modSLA) surface. Thus, 48 study implants were placed. Implant stability was assessed using Resonance Frequency Analysis (RFA). Readings were taken from the buccal and proximal directions for each implant. Implant stability (ISQ) was assessed at the time of surgical placement (baseline) and 2, 3, 4, 6, 8, 10, 12, and 16 weeks following implant placement. RESULTS: No significant differences in implant stability were observed between conventional SLA implants and modSLA implants, and the time courses of implant stabilization following implant placement were similar for the two implant types. Baseline ISQ and minimum ISQ was slightly higher in subjects with higher HbA1c levels, but were similar during 12-16 weeks following implant placement. Forty-seven (98%) of the 48 implants were determined to be successfully osseointegrated and continued to restoration. CONCLUSION: Implant stabilization was similar for the conventional SLA and chemically modified SLA implants in type 2 diabetic patients with relatively poor glycemic control. Furthermore, this study demonstrated clinically successful implant placement even in poorly controlled diabetic patients.

Using an existing denture to design a radiographic template for a two-implant mandibular overdenture.

This article describes a technique for modifying an existing mandibular complete denture for use as a radiographic template with a radiopaque light-activated calcium hydroxide (Ca(OH)(2)) preparation. This allows prosthetically driven treatment planning and the surgical placement of 2 implants to support the existing mandibular denture.

The quality of dental faculty work-life: report on the 2007 dental school faculty work environment survey.

This report is the third in a series of articles on the dental school work environment commissioned by the American Dental Education Association's Commission on Change and Innovation in Dental Education. The report is based on the most extensive research to date on faculty satisfaction in the dental school environment. The purpose of the study was to assess faculty perceptions and recommendations related to work environment, sources of job satisfaction and dissatisfaction, and professional development needs. More broadly, the study intends to provide insight into the "change readiness" of dental schools to move forward with curricular improvements and innovations. Findings are based on 1,748 responses from forty-nine U.S. dental schools obtained during the time frame of February to April 2007. The total number of respondents constituted 17 percent of all U.S. dental school faculty. The average response rate per school was thirty-six (21 percent). To elucidate the data in terms of issues related to the quality of faculty work-life based on demographics, the authors compared perceptions of various aspects of the work culture in academic dentistry among faculty with different academic ranks and academic degrees and by other variables such as age and gender, tenure versus non-tenure appointments, and full- versus part-time status. Quantitative and qualitative analyses show that the majority of faculty members described themselves as very satisfied to satisfied with their dental school overall and with their department as a place to work. Tenured associate professors expressed the greatest level of dissatisfaction. Opportunities for and support of professional development emerged as an area requiring substantially more attention from dental schools. The authors of the study suggest that dental school leaders use these findings to assess their individual dental school's work environment and to plan changes as needed.

Criterios de decisión en el uso de sellantes de fosas fisuras

En la actualidad, la prevención de caries es lo más importante en la profesión odontológica. Entre los tratamientos de prevención se encuentran los sellantes de fosas y fisuras que, con el pasar del tiempo se ha demostrado su eficiencia; sin embargo, si no se realiza un correcto diagnóstico, este en lugar de ser un aliado, puede resultar contraproducente. En este estudio se hizo un análisis de los factores personales y características dentales del niño que, toman en cuenta los estudiantes, para la colocación de sellantes de fosas y fisuras en las piezas dentales de los pacientes. Se realizó un cuestionario donde cada una de las preguntas representaba un factor y una característica. Como conclusión se obtuvo que los criterios de decisión utilizados por los estudiantes tanto de clínicas II como de clínicas III, fueron acertados. Si se toma la cantidad de criterios aplicados, de los 12 en total, todos ellos informados en la literatura científica, los alumnos de clínicas II utilizan 10 de ellos y los de clínicas III 8 de ellos, por lo que se puede decir que el criterio de los primeros es más acertado que el de los segundos.

The prevention of caries is the important in the dental profession. Among the prevention treatments are the sealants of pit and fissure, whose efficiency has been proven over time, however, if a correct diagnosis is not performed, this rather than being an ally can be counterproductive. In this study an analysis was made of, the personal factors and dental characteristics of the child that are taken into account by the students, for the placement of sealants for pit and fissure in children. It was done through a questionnaire where each of the questions represented a factor and a characteristic. In conclusion, it was obtained that the decision criteria used by the students of both clinics II and clinics III were right.If we take the number of criteria applied,12 in total, all of them reported in the scientific literature, the students of clinics II use 10 of them and those of clinics III 8 of them, so it can be said that the criterion of the first is more accurate than that of the seconds.