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Avaliação da resposta inflamatória peri-implantar em pacientes portadores de diabetes tipo 1 : uma revisão sistemática
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Abstract(s)
Introdução: A colocação de implantes dentários em pacientes com diabetes mellitus, tradicionalmente considerada uma contraindicação devido às complicações relacionadas à cicatrização e infeções, tem sido reavaliada à luz de novos estudos. A diabetes mellitus tipo 1, caracterizada pela destruição autoimune das células beta do pâncreas e resultando em um deficit absoluto de insulina, pode complicar ainda mais o tratamento dentário devido à hiperglicemia e suas consequências. Recentemente, diversos estudos, indicam que, com um controlo glicémico rigoroso, é possível alcançar resultados favoráveis na reabilitação com implantes dentários em pacientes diabéticos. Objetivo: Avaliar a resposta inflamatória peri-implantar em pacientes portadores de diabetes tipo 1. Metodologia: Foi efetuada uma pesquisa de artigos em Inglês e Português nas bases de dados Cochrane Library, PUBMED, EMBASE e Google Académico e sem restrições temporais. Foram utilizados os critérios do protocolo PICO para a formulação da pergunta da pesquisa. A análise dos dados foi conduzida com o auxílio da ferramenta PRISMA para garantir a transparência e a qualidade na apresentação dos resultados. Utilizou-se a Joanna Briggs Institute (JBI) e a Escala Newcastle-Ottawa (NOS) para avaliar o risco de viés dos estudos, e o sistema GRADE foi aplicado para classificar a qualidade da evidência. Resultados: Em termos gerais, não se observam contradições importantes entre os resultados dos seis estudos incluídos. Todos eles concordam que a diabetes tipo 1 está associada a uma resposta inflamatória aumentada, sendo que a falta de controlo glicémico pode prejudicar a integração e a longevidade dos implantes dentários. A taxa de sobrevivência dos implantes e os índices clínicos peri-implantares mostraram-se comparáveis entre esses grupos, sugerindo que o controlo glicémico efetivo desempenha um papel relevante na prevenção de complicações. Conclusão: Observa-se que, quando a diabetes é bem controlada, os resultados dos implantes dentários em pacientes diabéticos tipo 1 não diferem significativamente dos de indivíduos saudáveis. Portanto, a diabetes não pode ser considerada uma contraindicação absoluta para a colocação de implantes. No entanto, é fundamental sublinhar a necessidade de realizar mais estudos para aperfeiçoar as recomendações e garantir a validade clínica.
Introduction: The placement of dental implants in patients with diabetes mellitus, traditionally considered a contraindication due to complications related to healing and infections, has been reassessed in light of new studies. Type 1 diabetes mellitus, characterized by autoimmune destruction of pancreatic beta cells resulting in an absolute insulin deficiency, can further complicate dental treatment due to hyperglycemia and its consequences. Recently, various studies indicate that with strict glycemic control, favorable outcomes in dental implant rehabilitation can be achieved in diabetic patients. Objective: To evaluate the peri-implant inflammatory response in patients with type 1 diabetes. Methodology: A literature search was conducted for articles in English and Portuguese in the Cochrane Library, PUBMED, EMBASE, and Google Scholar databases without time restrictions. The PICO protocol criteria were used to formulate the research question. Data analysis was conducted using the PRISMA tool to ensure transparency and quality in the presentation of results. The Joanna Briggs Institute (JBI) and the Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias in the studies, and the GRADE system was applied to rate the quality of the evidence. Results: Overall, no significant contradictions were observed among the results of the six included studies. All studies agree that type 1 diabetes is associated with an increased inflammatory response and that poor glycemic control can impair the integration and longevity of dental implants. The survival rate of implants and peri-implant clinical índices were comparable among these groups, suggesting that effective glycemic control plays a crucial role in preventing complications. Conclusion: It is observed that when diabetes is well controlled, the outcomes of dental implants in type 1 diabetic patients do not differ significantly from those of healthy individuals. Therefore, diabetes should not be considered an absolute contraindication for implant placement. However, it is essential to emphasize the need for further studies to refine recommendations and ensure clinical validity.
Introduction: The placement of dental implants in patients with diabetes mellitus, traditionally considered a contraindication due to complications related to healing and infections, has been reassessed in light of new studies. Type 1 diabetes mellitus, characterized by autoimmune destruction of pancreatic beta cells resulting in an absolute insulin deficiency, can further complicate dental treatment due to hyperglycemia and its consequences. Recently, various studies indicate that with strict glycemic control, favorable outcomes in dental implant rehabilitation can be achieved in diabetic patients. Objective: To evaluate the peri-implant inflammatory response in patients with type 1 diabetes. Methodology: A literature search was conducted for articles in English and Portuguese in the Cochrane Library, PUBMED, EMBASE, and Google Scholar databases without time restrictions. The PICO protocol criteria were used to formulate the research question. Data analysis was conducted using the PRISMA tool to ensure transparency and quality in the presentation of results. The Joanna Briggs Institute (JBI) and the Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias in the studies, and the GRADE system was applied to rate the quality of the evidence. Results: Overall, no significant contradictions were observed among the results of the six included studies. All studies agree that type 1 diabetes is associated with an increased inflammatory response and that poor glycemic control can impair the integration and longevity of dental implants. The survival rate of implants and peri-implant clinical índices were comparable among these groups, suggesting that effective glycemic control plays a crucial role in preventing complications. Conclusion: It is observed that when diabetes is well controlled, the outcomes of dental implants in type 1 diabetic patients do not differ significantly from those of healthy individuals. Therefore, diabetes should not be considered an absolute contraindication for implant placement. However, it is essential to emphasize the need for further studies to refine recommendations and ensure clinical validity.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Peri-implante Diabetes Implantes dentários Osseointegração