Radiographic Bone Density Around Immediately Placed Titanium Implant on the Extraction Socket of Diabetic and Insulin-Treated Rat Maxilla

당뇨쥐 상악에서 발치후 즉시 식립 임플란트 주위골의 방사선 골밀도

  • Park, Kun-Hyun (Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dental Science, The Catholic University) ;
  • Park, Su-Hyun (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University) ;
  • Lee, Sung-Hwy (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University) ;
  • Pyo, Sung-Woon (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University)
  • 박건현 ;
  • 박수현 (가톨릭대학교 부천성모병원 구강악안면외과) ;
  • 이성휘 (가톨릭대학교 부천성모병원 구강악안면외과) ;
  • 표성운 (가톨릭대학교 부천성모병원 구강악안면외과)
  • Received : 2010.08.04
  • Accepted : 2010.09.03
  • Published : 2010.09.30

Abstract

Purpose: Although it is generally accepted that patients with controlled diabetes have similar rates of success for dental implants as healthy individuals, the use of dental implants in diabetic patients is controversial. In addition, the impact of diabetes on the healing of bone associated with immediately place dental implants is not completely understood. The purpose of this study was to measure bone response to implants radiologically in uncontrolled and insulin-controlled diabetic rats. Materials and Methods: Twenty rats were divided into control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. Two titanium implants ($1.2{\times}3$ mm) were placed in the extraction socket of the maxillary first molars of the animals and were harvested at 3 days, 1, 2 and 4 weeks. The bone density was measured by digital radiography using gray-level analysis (histogram) in the regions of interest (ROI) at four points: two mesial and two distal to both sides of the implant. Results: The results showed that the osseointegration of the implants was impaired in the diabetic rats compared to the control and the insulin-treated rats. The radiographic evidence demonstrated marked destruction of bone around the implants in the diabetic group. Both the control and the insulin-treated groups had a significantly higher bone density on radiograph than the diabetic group from the 1 week of the experiment (P<0.05 for each comparison). Conclusion: The present study revealed that the immediate placement of titanium implants in the maxilla of diabetic rat lead to delay in the maturation of bone adjacent to implants. It is expected that the reduced predictability of success of immediate implantation in patient with the uncontrolled diabetes.

Keywords

References

  1. McMurry JF Jr : Wound healing with diabetes mellitus. Better glucose control for better wound healing in diabetes. Surg Clin North Am 64 : 769, 1984. https://doi.org/10.1016/S0039-6109(16)43393-1
  2. Sugerman PB, Barber MT : Patient selection for endosseous dental implants : oral and systemic considerations. Int J Oral Maxillofac Implants 17 : 191, 2002.
  3. Kotsovilis S, Karoussis IK, Fourmousis I : A comprehensive and critical review of dental implant placement in diabetic animals and patients. Clin Oral Implants Res 17 : 587, 2006. https://doi.org/10.1111/j.1600-0501.2005.01245.x
  4. Mombelli A, Cionca N : Systemic diseases affecting osseointegration therapy. Clin Oral Implants Res 17 : 97, 2006. https://doi.org/10.1111/j.1600-0501.2006.01354.x
  5. Alsaadi G, Quirynen M, Komarek A et al : Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection. J Clin Periodontol 34 : 610, 2007. https://doi.org/10.1111/j.1600-051X.2007.01077.x
  6. Moy PK, Medina D, Shetty V et al : Dental implant failure rates and associated risk factors. Int J Oral Maxillofac Implants 20 : 569, 2005.
  7. Ferreira SD, Silva GLM, Cortelli JR et al : Prevalence and risk variables for peri-implant disease in Brazilian subjects. J Clin Periodontol 33 : 929, 2006. https://doi.org/10.1111/j.1600-051X.2006.01001.x
  8. Romanos GE, Testori T, Degidi M et al : Histologic and histomorphometric findings from retrieved, immediately occlusally loaded implants in humans. Compend Contin Educ Dent 76 : 1823, 2005.
  9. Chaushu S, Tzohar A, Dayan D : Immediate loading of single-tooth implants : immediate versus non-immediate implantation. A clinical report. Int J Oral Maxillofac Implants 16 : 267, 2001.
  10. Shyng YC, Delvin H, Ou KL : Bone formation around immediately placed oral implants in diabetic rats. Int J Prosthodont 19 : 513, 2006.
  11. Nevins ML, Karimbux NY, Weber HP et al : Wound healing around endosseous implants in experimental diabetes. Int J Oral Maxillofac Implants 13 : 620, 1998.
  12. Takeshita F, Murai K, Iyama S et al : Uncontrolled diabetes hinders bone formation around titanium implants in rat tibiae. A light and fluorescence microscopy, and image processing. J Periodontol 69 : 314, 1998. https://doi.org/10.1902/jop.1998.69.3.314
  13. Siqueira JT, Cavalher-Machado SC, Arana-Chavez VE et al : Bone formation around titanium implants in the rat tibia : role of insulin. Implant Dent 12 : 242, 2003. https://doi.org/10.1097/01.ID.0000074440.04609.4F
  14. Fiorellinin JP, Nevins ML, Norkin A et al : The effect of insulin therapy on osseointegration in a diabetic rat model. Clin Oral Implants Res 10 : 362, 1999. https://doi.org/10.1111/j.1600-0501.1999.tb00011.x
  15. Kwon PT, Rahman SS, Kim DM et al : Maintenance of Osseointegration Utilizing Insulin Therapy in a Diabetic Rat Model. J Periodontol 76 : 621, 2005. https://doi.org/10.1902/jop.2005.76.4.621
  16. Graves DT, Al-Mashat H, Liu R : Evidence that diabetes mellitus aggravates periodontal diseases and modifies the response to an oral pathogen in animal models. Compend Contin Educ Dent 25 : 38, 2004.
  17. Takeshita F, Iyama S, Ayukawa Y et al : The effects of diabetes on the interface between hydroxyapatite implants and bone in rat tibia. J Periodontol 68 : 180, 1997. https://doi.org/10.1902/jop.1997.68.2.180
  18. McCracken MS, Aponte-Wesson R, Chavali R et al : Bone associated with implants in diabetic and insulin-treated rats. Clin Oral Implants Res 17 : 495, 2006. https://doi.org/10.1111/j.1600-0501.2006.01266.x
  19. Masaki S, Noritaka F, Hideo O et al : Tissue response to titanium implantation in the rat maxilla, with special reference to the effects of surface conditions on bone formation. Clin Oral Implants Res 14 : 687, 2003. https://doi.org/10.1046/j.0905-7161.2003.00960.x
  20. Taba-Junior M, Novaes AB Jr, Souza SL et al : Radiographic evaluation of dental implants with different surface treatments : an experimental study in dogs. Implant Dent 12 : 252, 2003. https://doi.org/10.1097/01.ID.0000075580.55380.E5
  21. Novaes AB Jr, Souza SL, Oliveira PT et al : Histomorphometric analysis of the bone-implant contact obtained with 4 different implant surface treatments placed side by side in the dog mandible. Int J Oral Maxillofac Implants 17 : 377, 2002.
  22. Sakakura CE, Margonar R, Holzhausen M et al : Influence of cyclosporin A therapy on bone healing around titanium implants: a histometric and biomechanic study in rabbits. J Periodontol 74 : 976, 2003. https://doi.org/10.1902/jop.2003.74.7.976
  23. van Steenberghe D, Quirynen M, Molly L et al : Impact of systemic diseases and medication on osseointegration. Periodontol 2000 33 : 163, 2003. https://doi.org/10.1046/j.0906-6713.2003.03313.x
  24. Takeshita F, Iyama S, Ayukawa Y et al : The effects of diabetes on the interface between hydroxyapatite implants and bone in rat tibia. J Periodontol 68 : 180, 1997. https://doi.org/10.1902/jop.1997.68.2.180
  25. Hasegawa H, Ozawa S, Hashimoto K et al : Type 2 diabetes impairs implant osseointegration capacity in rats. Int J Oral Maxillofac Implants 23 : 237, 2008.
  26. Follak N, Kloting I, Wolf E et al : Improving metabolic control reverses the histomorphometric and biomechanical abnormalities of an experimentally induced bone defect in spontaneously diabetic rats. Calcif Tissue Int 74 : 551, 2004. https://doi.org/10.1007/s00223-003-0069-6
  27. Hausmann E : Radiographic and digital imaging in periodontal practice. J Periodontol 71 : 497, 2000. https://doi.org/10.1902/jop.2000.71.3.497
  28. Mawatari T, Miura H, Higaki H et al : Effect of vitamin K2 on three-dimensional trabecular microarchitecture in ovariectomized rats. J Bone Miner Res 15 : 1810, 2000.
  29. Krakauer JC, McKenna MJ, Buderer NF et al : Bone loss and bone turn over in diabetes. Diabetes 44 : 775, 1995. https://doi.org/10.2337/diabetes.44.7.775