An umbrella review on the effects of diabetes on implant failure and peri-implant diseases

Abstract The aim of this review is to summarize the evidence on associations between diabetes mellitus (DM) and complications around dental implants. Electronic database searches of MEDLINE, EMBASE, JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews and the PROSPERO register were performed from 1990 up to and including May 2018, using MeSH terms and other keywords. Systematic reviews and meta-analyses investigating the associations of DM and implant complications (failure, survival, bone loss, peri-implant diseases, and post-surgery infection) were eligible. The quality of the included reviews was determined using the Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2). Twelve systematic reviews were included. Implant survival rates ranged from 83.5% to 100%, while implant failure rates varied from 0% to 14.3% for subjects with DM. The three meta-analyses performed for event “implant failure” reported no statistically significant differences between diabetic and non-diabetic subjects. An apparently increased risk of peri-implantitis is reported in patients with DM. According to the AMSTAR 2 classification, 50% of the reviews were classified as being of “critically low”, 25% as of “low” and 25% as of “moderate” quality. Evidence indicates high levels of survival and low levels of failure of implants inserted in patients with DM. However, DM was assessed as a whole in the majority of studies and, the actual influence of hyperglycemia on implant survival/failure is still uncertain. DM/hyperglycemia seems to be associated with a high risk of peri-implantitis. However, this conclusion is based on a limited number of systematic reviews.

摘要 本综述旨在总结糖尿病（DM）与牙种植体周围并发症之间关联的相关证据。研究于1990年至2018年5月（含2018年5月）期间，采用医学主题词表（MeSH terms）及其他关键词，对MEDLINE、EMBASE、JBI系统综述与实施报告数据库、Cochrane系统综述数据库以及PROSPERO注册库进行了电子数据库检索。本综述纳入了探究糖尿病与种植体并发症（包括种植体失败、留存情况、骨丢失、种植体周围疾病以及术后感染）之间关联的系统综述和荟萃分析。采用系统综述评价工具2（AMSTAR 2）对纳入的综述的质量进行评估。最终纳入12项系统综述。糖尿病患者的种植体留存率范围为83.5%至100%，而种植体失败率范围为0%至14.3%。针对"种植体失败"这一结局开展的3项荟萃分析结果显示，糖尿病患者与非糖尿病患者之间无统计学显著性差异。现有研究提示糖尿病患者罹患种植体周围炎的风险可能升高。根据AMSTAR 2的质量分级标准，50%的综述被评为"极低质量"，25%被评为"低质量"，剩余25%被评为"中等质量"。现有证据表明，糖尿病患者植入的种植体留存率较高、失败率较低。然而，多数研究均将糖尿病作为整体进行评估，高血糖症对种植体留存/失败的实际影响仍不明确。糖尿病/高血糖症似乎与种植体周围炎的高风险相关，但该结论仅基于有限的系统综述研究。