JSM Diabetology and Management

Use of Dental Implants in Diabetic Patients. Review of Literature

Review Article | Open Access | Volume 6 | Issue 1
Article DOI :

  • 1. Maxillofacial surgeon, Central clinical Military hospital (Ministry of Defence of The Republic of Armenia), Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Armenia
  • 2. Professor Head of Department Endocrinology Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
  • 3. Professor, Head of Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Armenia
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Corresponding Authors
Professor Gagik Hakobyan, Head of Department of Oral and Maxillofacial Surgery, Yerevan State Medical University, Yerevan State, Armeniaa

Background: Prosthetic restoration with dental implants in diabetic patients has certain features, because in these patients, due to various factors, the osseointegration processes can be disrupted, in addition, in these groups of patients, the risk of peri-implantitis during functional load is also high.

Objective: The aim of this literature review was to summarize the influence of risk factors on dental implant failure in diabetic patients.

Methods: Search strategy was applied with the aim of identifying as many relevant publications as possible. Data Sources four electronic databases were searched: PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials.

The key words used for the search were dental implant failure risk factors, osteointegration failure risk factors, the use of implants, Implants in diabetic patients, use of photofunctionalized implants in at-risk patients. Of the 146 studies identified, screening resulted in a further 54 articles being excluded for failure to report the specific cause of failure, leaving only 92 studies ultimately included in this review.

Results: Common risk factors for implant failure are related to patient history (radiation therapy, diabetes, periodontitis, use medications): any stage of the implantation treatment of patients of the risk group, an interdisciplinary approach should be taken, starting with planning and including long-term dynamic monitoring.

In this review, the author analyzes the prospect of using photofunctionalized implants in patients with diabetic.

Conclusion: Patients with diabetes mellitus have a risk implant complications, but by maintaining glycemic control, supportive periodontal therapy, regular periodontal maintenance, and the use of photofunctionalized implants, predictable results can be achieved and risks can be reduced.


• Metformin

• Dental implants

• Photofunctionalization

• Risk of implant failure

• Diabetic patients

• Glycemic control


Khachatryan H, Aghajanova E, Gagik Hakobyan D (2024) Use of Dental Implants in Diabetic Patients. Review of Literature. JSM Diabetol Manag 6(1): 1008.


Along with the widespread use of dental implants in patients with various forms of teeth loss, literature reports the inability of osteointegration and peri-implantitis, especially in patients with risk. These failures can be classified into early failure and late failure, failures occurring after the application of functional load [1].

The risk of implant failure includes general and local factors [2].

General factors include: the use of implants in patients with general somatic contraindications [3,4].

Local factors include: the presence of aggressive periodontitis in patient, residual inflammatory foci in the implantation area, osteoporosis, use of non-standardized implants, violation of sterility and contamination of the implant surface, violation of surgical standards (overheating of the bone during preparation, damage to anatomical structures, lack of primary stabilization, premature loading in case of contraindications) and oder [5-9].

Currently, one of the urgent tasks of implantology is to increase the efficiency of implantation in healthy compromised patients and one of the ways to solve is the manifestation of an interdisciplinary approach [10].

Patients with compromised healthy predisposition to various complications during both direct surgical intervention and in the long-term period and due to various factors (use medications, cancer therapy, smoking, bone ailments, decreased immunity, diabetes mellitus, impaired microcirculation, slow wound healing, age, and etc.) therefore, it is necessary to take precautions in various stages of implant treatment [11].

In practice, implantologists most often encounter patients with systemic diseases, among which the most common are patients use medications, endocrine disorders, including: diabetes mellitus, bone diseases: osteoporosis, etc [12-17]. Among patients with endocrine diseases, most doctors’ encounter in implantology practice are patients with diabetes mellitus [18].

According to the International Diabetes Federation, the prevalence of diabetes has increased significantly over the past few decades and the federation predicts an increase in the incidence of diabetes.

Intraoral manifestations of diabetes mellitus are: aggressive periodontal disease, alveolar bone loss, salivary gland dysfunction, dry mouth, taste disturbances, fungal and bacterial infections, impaired healing of oral wounds, and tooth loss [19- 22]. In patients with diabetes mellitus, microcirculation disorders lead to the regeneration of soft tissues of the oral cavity and bone healing processes are disrupted [23].

One of the most common lesions of the oral cavity in patients with diabetes is increased destruction of periodontal tissue as a result of impaired vascularization, decreased blood flow decreased function of polymorphonuclear leukocytes [24]. In patients with diabetes mellitus, tooth loss leads to poor digestion with poor metabolic control, this requires comprehensive prosthetic rehabilitation that will allow the patient to improve nutritional affect the success of dental implantation [25].

Due to resorption of the alveolar processes in diabetics with total edentulous prosthetic restoration with a conventional prosthesis is ineffective, who needs a dental implantation solved by more advanced methods. The opinion on the use of dental implants in patients with diabetes is ambiguous for specialists, some consider diabetes relative contraindications, others do not share this opinion and believe that implants can be effectively used [26,27].

According to various publications, patients with diabetes have postoperative complications associated with implant deficiency and peri-implantitis after implant therapy [23,28,29]. According to Juliane Wagner et al. (2022), patients with poorly controlled diabetes have higher rates of peri-implantitis, and these patients have higher rates of implant loss in the long term than healthy individuals [30].

The process of osseointegration depends not only on the level of bone tissue metabolism, but also on the state of immune homeostasis of the oral mucosa of patients with implants [31]. With diabetes, the synthesis of protein is disturbed, the activity and maturation of osteoblasts is impaired, which operates bone mineralization in the surgical region and slows down the healing of the tissue [32,33].

In patients with diabetes mellitus, the growth and accumulation of extracellular bone matrix decreases, which leads to bone fragility, bone formation decreases during the healing process [34]. Patients with diabetes have an increased risk of fracture and, therefore, the use of drugs (for example, metformin), which has a useful effect on bone cells, can be one of the approaches to prevent the destruction of diabetics bone [35].

Biochemical markers of bone formation and resorption tend to be lower in patients with diabetes [36]. According to G. Khachatryan and G. Hakobyan (2023), monitoring in the blood serum of patients with type 2 diabetes mellitus the concentration of bone metabolism markers osteocalcin and β-Cross-Laps can have prognostic significance for implants and will help the practitioner apply corrective drug therapy [37]. Violation concentration level biochemical markers of bone directly or indirectly affect the process of osseointegration, vascularization of the flap, can cause infection of soft tissues and slow down healing, which will affect the survival rate of dental implants and can lead to implant failure [38].

The prognosis of the results of dental implantation is also influenced by the presence of periodontitis and a decrease in the immune response in patients with diabetes mellitus, which increases the prevalence of postoperative infection and contributes to peri-implantitis [39-41]. However, there are scientific publications that report that successful osseointegration of a dental implant can be achieved in patients with diabetes with good metabolic control [42,43].

In patients with diabetes mellitus, protocols developed in general surgical practice are used, which include the following: control diet and hypoglycemic drugs, special aseptic methods and strict antibiotic prophylaxis [44-46]. Despite the increased risk, dental implantation remains the optimal treatment option for diabetes mellitus, allowing patients to regain chewing function and thereby expand their food choices, which can have a positive effect on digestion.

Thus, glycemic control and optimization of osseointegration is one of the main factors for long- term effective implantation therapy in patients with diabetes mellitus. Thus, for successful implantation in patients with diabetes, it is only necessary to adhere to the general surgical protocol for patients in this category, but also to improve osseointegration [47].

To improve osseointegration and increase the efficiency of bone-implant contact, biomedical research is aimed at modifying the implant surface [48].

Currently, various methods are used to modify the surface of titanium implants, this leads to increase the area of contact with the bone [49]. Modification of the implant surface improves the hydrophilicity of the surface, which enhances cell migration, thereby accelerating the process of osseointegration [50]. Surface modification methods include plasma surface, oxidation or additive processes, surface acid treatment (SLA), micro-arc oxidation, vacuum procedures, physical methods: alkaline heat treatment (AH) and laser melting [51-55].

Currently, UV irradiation, or photofunctionalization, is one of the methods for treating the implant surface that improves the process of osseointegration [56,57]. Photofunctionalization causes the formation of an electrostatic state of the titanium surface, transformation of the surface from hydrophobic to superhydrophilic, activation of protein absorption, and increased activity of fibroblasts and osteoblasts [58-62]. Changes in the properties of the implant surface following photofunctionalization and the impact on implantation success, healing time, rate of osseointegration and changes in the level of marginal bone around the implant were first studied in clinical cases by Akiyoshi Funato and Takahiro Ogawa in 2013 [63]. Photofunctionalization of implant surfaces effective method for optimizing osseointegration [64-66].

One of the main factors causing implantation failure is the adhesion of microorganisms to dental implants, the components releasing which can stimulate inflammatory reactions in the peri-implant tissues [67-73]. UV irradiation not only improves the adhesion of osteoblasts on the surface of titanium implants, but also has an antimicrobial effect, reduces the amount of attachment/accumulation of bacteria and their components on the surface of the implant [74-86].

This can have an antimicrobial effect, thereby playing an important role in the complex of prevention and prevention of peri-implantitis [87-92].

The use of photofunctionalized implants in diabetic patients can increase the effectiveness of prosthetic treatment and reduce the risk of complications. However, long-term multicenter studies are needed to determine whether photofunctionalization reduces the risk of peri-implant complications and can play a preventive role in peri-implant complications in diabetic patients.


Patients with diabetes mellitus have a risk implant complications, but by maintaining glycemic control, supportive periodontal therapy, regular periodontal maintenance, and the use of photofunctionalized implants, predictable results can be achieved and risks can be reduced.


The author acknowledge scientific advisor professor Gagik Hakobyan, Head of Department of Oral and Maxillofacial Surgery, University of Yerevan State Medical University, Yerevan State, Armenia for conceptualization and final revue. Authors read and approved the final manuscript.

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Khachatryan H, Aghajanova E, Gagik Hakobyan D (2024) Use of Dental Implants in Diabetic Patients. Review of Literature. JSM Diabetol Manag 6(1): 1008.

Received : 19 Jan 2024
Accepted : 31 Jan 2024
Published : 01 Feb 2024
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ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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