Taking Out All Teeth and Replacing Them With Dentures That Rest on Implants in People With Type 2 Diabetes
Recruitment status was: Active, not recruiting
Gum disease and type 2 diabetes are common chronic diseases that affect each other. Diabetes is increasing, especially in Pakistan. People with diabetes have a greater risk for gum disease. Also, it is thought that that gum disease, a chronic infection, can be a source of systemic inflammation and may contribute to poorer diabetes control.
The aims of this project are to study:
- Changes in sugar control in people with type 2 diabetes and severe gum disease after having all teeth removed and replaced with Straumann dental implants and full dentures
- Changes in certain inflammation markers seen with insulin resistance and other diseases and conditions more common in people with diabetes
- Retention of dental implants in people with type 2 diabetes.
The study will recruit 30 patients with type 2 diabetes and severe gum disease from Dr. Amin Rahman's private practices in Pakistan. Their long-term sugar (HbA1c) must be 7.5% or more and the inflammatory marker, C-reactive protein (hsCRP) 1mg/dL or more. Consenting participants will first have an oral examination. Eligible patients will have impressions of the jaws and the color of their teeth and gums recorded. At the next visit, all teeth will be extracted and dentures provided. One week later, there will be a check-up visit. Three months after the teeth were removed, Straumann dental implants will be placed in the jaws. After one week, the patient will be checked again. After three months, the dentures will be adjusted to fit the implants. Follow-up visits will occur every three months until one year after the implants were placed, then every six months for the next five years, to check the health of the patients as well as their implants, the gums around them, and the dentures. Blood samples will be taken at each follow-up visit.
Our hypotheses are that levels of HbA1c and hsCRP will:
- decrease after extraction of all teeth
- not increase after placement of dental implants
- not increase after prosthetic restoration with full dentures anchored on the dental implants.
|Type 2 Diabetes Mellitus With Hyperglycemia Inflammation Post-osseointegration Mechanical Failure of Dental Implant||Other: All teeth out, full dentures, dental implants, blood draw||Phase 1 Phase 2|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Screening
|Official Title:||Effect of Extractions and Straumann Dental Implants on Glycemic Control and Inflammatory Markers in Patients With Diabetes: A Pilot Study|
- Glycosylated hemoglobin (HbA1a) [ Time Frame: Every 3 months/6 months ]Level measured every 3 months during the first year after implant placement; then every 6 months the following 5 years, for a total of 6 years.
- high-sensitivity C-reactive protein (hsCRP) [ Time Frame: Every 3 months/6 months ]Level measured every 3 months during the first year after implant placement; then every 6 months the following 5 years, for a total of 6 years.
- Retention of implants [ Time Frame: 6 years ]Implants sometimes fail if placed in individuals with uncontrolled diabetes, recent infection/inflammation, and cigarette smoking habits. The intent is to evaluate retention of implants in such patients.
|Study Start Date:||June 2008|
|Estimated Study Completion Date:||December 2016|
|Primary Completion Date:||December 2011 (Final data collection date for primary outcome measure)|
|Experimental: All teeth out, full dentures, dental implants, blood draw||
Other: All teeth out, full dentures, dental implants, blood draw
All teeth were extracted and replaced by a set of provisional full dentures in upper and lower jaws. Three months after extractions, dental implants were surgically placed and mucosa sutured over them. Three monts later, the dentures were re-lined and fitted onto the implants. Blood draw done by phlebotomist.
Only one arm was included due to ethical reasons: Once potential participants would be diagnosed with terminal periodontal (gum) disease, they would need full-mouth extraction and prosthetic rehabilitation. Therefore, no control group was included in study.
No studies have determined what happens to sugar control and inflammatory markers in people with diabetes if teeth with severe gum disease are removed and replaced with implants and dentures. Neither has any study followed for a total of 6 years after implant placement such subjects that initially had uncontrolled type 2 diabetes as well as recent severe periodontal infection, and several of whom smoke cigarettes.
Therefore, the results of this study could add new understanding about diabetes and dental health. The results of this study could influence dental care guidelines for treating people with type 2 diabetes and severe gum disease. The option of implant supported dentures could potentially be added to the treatment choices for such patients.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01774942
|Rahman & Rahman Dental Surgeons|
|Lahore, Punjab, Pakistan|
|Principal Investigator:||Wenche S Borgnakke, DDS MPH PhD||University of Michigan|
|Study Director:||Amin ur Rahman, BDS MPH Cert||Rahman & Rahman Dental Surgeons, Lahore, Pakistan|