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Diabetes is a chronic disease that affects each and every part of our body. It also affects the choices we can make while looking for permanent teeth replacement. We outline the reasons why as well as the best options available to diabetics.

Diabetes is one of the fastest-growing chronic diseases in the world [1]. The current modes of treatments are all aimed at managing the condition rather than treating or eliminating it from the body in the traditional sense. A part of what makes uncontrolled or poorly controlled diabetes so dangerous is the fact that it affects every part of the body, including the oral cavity [2].

This is why diabetes is a big consideration for doctors when planning for permanent teeth replacement in patients.

Permanent Tooth Replacement In Diabetic Patients

The number one factor that has to be taken into consideration before the planning of any long-term restorative procedure is the level of control over diabetes that the patient has. A well-controlled diabetic patient will respond to all treatment modalities in exactly the same manner as a non-diabetic individual and has the same risk profile for failure or success of the treatment [3].

A poorly controlled diabetic will have a markedly increased risk of failure of certain treatment modalities, as will be detailed later in this article.

To determine what kind of control the patient has over their diabetes, the doctor will order a few blood tests to check for fasting glucose levels, postprandial glucose levels (after eating), and the most important one, HbA1C levels.

This last one determines how well controlled the diabetic patient was over a period of three months [4].

It is very important for a doctor to know the state of diabetes control that a patient is practicing to have a reasonable idea of the kind of procedures and the risk involved. Let us take a detailed look at each of the permanent tooth replacement options in diabetic patients.

Dental Implants In Diabetic Patients

Diabetes is a very difficult disease to manage because it often requires discipline and a change in lifestyle habits that are alien to the people affected. It is also a very dangerous disease that counts among its complications neuropathy (neural degeneration), retinopathy (degeneration of the retina), nephropathy (kidney disease) and an increased incidence of cardiac disorders [5].

Another complication, although not as life-threatening as the ones mentioned earlier, is also very closely associated with diabetes. This is periodontitis or gum disease [6].

The speed of spread of periodontitis as well as the severity of the disease is markedly increased in diabetics. Since gum disease affects the dental implants as well (called periimplantitis), it must be considered during the planning stage [7].

A poorly controlled diabetic patient will be more likely to suffer from dental implant failure, both during the initial stage of healing as well as over the long term. This "increased risk" is difficult to quantify but some studies have shown a 20% increased failure rate in poorly controlled diabetics than well-controlled diabetics [8].

If the diabetic patient in question is also a smoker then the alarm bells really start ringing. The maximum risk of failure of implant treatment comes from poorly controlled diabetic patients that are also heavy smokers [9].

We would not advise extensive implant treatment in patients without prior counseling and some amount of behavior modification to bring the conditions under control.   

For well-controlled diabetic patients, the risk of failure of dental implants is the same as a non-diabetic individual, however, they must understand that they need to take stringent care throughout their lives to prevent the complications of diabetes start to appear in their bodies.

Crowns And Bridges In Diabetic Patients

There are some misconceptions in people that say that diabetic patients should not get dental implants and stick only to crowns and bridges. This is absolutely not true. Gum disease affects both the natural teeth and implants, so there is nothing that makes crowns and bridges more likely to succeed in diabetics.

In fact, there is an increased amount of plaque accumulation at the margins of the crowns and bridges that actually increases the likelihood of gum disease developing [10].

Crowns and bridges take support from the teeth and not the bone so if the patient has healthy, supporting teeth with a good amount of bone around them then there is some advantage in going with the conservative option.

Patients do not need to worry about the initial healing process that accompanies a surgical procedure and the cost involved in much lesser so even if there is a failure the monetary loss is much smaller.

Conclusion

The evidence overwhelmingly states that the long-term success of a permanent tooth replacement in diabetics is dependent on the kind of control over the disease rather than on the kind of method used. Just because a person is diabetic does not mean that they should be denied the best possible treatment available.

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