الفهرس 
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Abstract
Implants are widely used to replace missing teeth with excellent success rates in healthy individuals. On the other hand, diabetic patients who usually suffer from partial or total edentulism are considered to be an area of controversy regarding the use of dental implants to replace their missing teeth, as diabetes could contribute to implant failure.
This study compared hydrophilic SLActive dental implant regarding its stability and peri-implant crestal bone levels in both controlled and poorly controlled diabetic patients.
A total of twenty bone level SLActive implants were divided evenly into two groups (Ten implants per group), of twelve diabetic patients whom were missing one or more teeth in the lower posterior segment) with a maximum of two implants per patient), according to their preoperative glycosylated haemoglobin levels (HbA1c). GroupI: (positive control) 6 patients with preoperative HbA1c levels ranging from 6.5% to 7.4%. group II: (treatment) six patients with preoperative HbA1c levels ranging from 7.5% to 9.5%. (One patient who received one implant was dropped out from this group)
A two stage protocol was followed; after implant insertion, patients had a healing period of six weeks. Patients were recalled to uncover the implants and replace the cover screws with healing abutments for a further two weeks. After a total of eight weeks after implant insertion impressions were taken to fabricate single non-splinted cementable crowns with a channel drilled into them to facilitate RFA measurements after one year of loading without damaging the crowns and for complete removal of excess cement as crowns are cemented to their abutments on the cast then unscrewed and transferred to their respective implants. These channels were then closed by Teflon and composite.
HbA1c levels were measured using HbA1c multi-test system. Measurements were taken once preoperatively to allocate each patient to one of the two groups. Also, it was measured after one year of loading to monitor average blood glucose levels during the study.
A CBCT was taken preoperatively to determine the adequacy of alveolar ridge, regarding bone level and height .Another scan was done immediately after implant placement to verify implant position and measure crestal bone level around it bucally, lingually, mesially and distally), using the top of implant platform as a reference point. One year after implant loading, the last CBCT scan was done to measure crestal bone levels (bucally, lingually, mesially and distally) and compares it to baseline CBCT.
RFA was the method used in this study to measure implant stability. ISQ values were first obtained immediately after implant insertion as a baseline and to assess primary stability. Another reading was taken six weeks after implant placement to determine the possibility of loading the implants. Final reading was done one year after implant loading to assess implant stability.
Concerning HbA1c levels, there was a statistically significant difference in mean HbA1c values between the two groups at base line (6.9% for group I and 8.9% for group II) and after one year (7.9% and 11.2% respectively), as the group I showed a statistically significant lower mean HbA1c level than group II.
The statistics also showed no statistically significant difference in HbA1c levels after one year for group I (P-value = 0.145, Effect size = 0.221), while for group II the difference was significant (P-value = 0.006, Effect size = 0.593).
The results showed no statistically significant difference regarding ISQ scores between the group I and group II at baseline (P-value = 0.621, Effect size = 0.016), after six weeks (P-value = 0.678, Effect size = 0.011) and after one year (P-value = 0.240, Effect size = 0.085). Also, there was no statistically significant change in ISQ scores by time regarding the group I (P-value = 0.256, Effect size = 0.166) and group II (P-value = 0.067, Effect size = 0.303), indicating that during the course of one year, the success of implant stability in both groups was comparable.
As for the crestal bone levels measured, there was no statistically significant difference between amounts of bone loss in the two groups (P-value = 0.664, Effect size = 0.105), thus indicating that during the course of one year, bone remodeling around SLActive dental implants in both groups I and II; wasn’t affected by the difference in HbA1c levels between these two groups.
The statistics also showed no significant difference in amount of bone loss by time within group I (P-value = 0.260, Effect size = 0.375), and group II (P-value = 0.779, Effect size = 0.099).
Augmenting these findings further, the statistics showed no significant direct correlation between ISQ scores and HbA1c levels after one year (r = 0.470, P-value = 0.145) and no significant direct correlation between amount of bone loss and HbA1c levels after one year (r = 0.396, P-value = 0.257).
Our findings demonstrate that hydrophilic SLActive dental implants may predictably be placed in patients with diabetes mellitus, irrespective of their actual glycemic status (HbA1c values up to 9.5%).
In conclusion
• SLActive dental implants could be loaded six weeks after insertion in diabetic patients with HbA1c levels up to 9.5% as evidenced by their ISQ scores.
• SLActive dental implants showed good results in both treatment and control groups after one year of insertion regarding their ISQ scores.
• SLActive dental implants exhibited no difference in levels of peri-implant crestal bone loss in both control and treatment groups over the course of one year.