Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 41

While diabetes mellitus type 1, which is caused by absolute insulin deficiency, only shows a prevalence of 0.02% worldwide, the incidence of diabetes mellitus type 2 is rapidly increasing, especially in the social underclasses of industrialized countries. In a few years, a morbidity rate of 10% in these societies is expected.

In these patients, in addition to the risk of a wound-healing disorder after grafting procedures or implant placement, the risk of peri-implantitis also increases.^30,70 In the area of the oral cavity, diabetic microangiopathy reduces the regenerative capacity of the oral mucosa, since the nutrition of the tissue is reduced due to damage to the capillaries. This often leads to extensive tissue necrosis with exposure of the augmented area, with partial or complete loss of the augmentation.⁸⁵

Table 2-2 Different anticoagulant medications and their doses

Since the circulation is restricted, the soft tissue seal of the osseointegrated implants, which is otherwise well accepted in endosseous implants, can already be disturbed during superficial bacterial colonization, so that the peri-implant bone is subject to infection. The medical treatment of the disease takes place according to the long-term blood sugar value of the glycohemoglobin or HbA1c, the value of which should be below 6%, which corresponds to a value of 120 mg/dl for the acute blood glucose value. From a value of 8%, the risk of healing complications and periodontal disease increases,⁸⁰ so that the indication should be carefully checked.⁵⁴ If, in the further course of the disease there are no signs of any disruption of the long-term blood glucose value, the prognosis for implant restorations is good.²⁹ Some studies show no increased failure rates in patients with diabetes in a two-step approach in case of bone augmentation, with appropriate patient guidance and a good maintenance program.^{14, 22}