I Have Diabetes: Is this a Contraindication for Implants and Grafts?

If your diabetes is well controlled, it should not interfere with your bone grafting or implant procedure. .If there is concern that the diabetes is NOT controlled, additional blood work can be ordered to check the HbA1c glycated hemoglobin in your blood. Nevertheless, diabetic patients still have a greater incidence of post-operative infection after these procedures, so home care and your periodontal condition should also be immaculate. Typically, the blood pressure and blood sugar will be taken at time of surgery. But again, to sum up, in general, controlled diabetes is not a contra-indication for bone grafting and dental implants, but infection is higher, and failure rate is slightly higher.Please also note, that when a sinus augmentation is performed, there will be some reduction in the volume of bone found months later as the regenerated bone forms. Typically the surgeon will add sufficient bone to compensate for this shrinkage, but a variety of factors may have prevented this. Your individual biology is a factor, as the rate in which your bone matures or resorbs will vary. Importantly, insufficient bone volume at time of planned placement in not necessarily the fault of the surgeon, but a result of many factors and can never be promised.As for cost of a second procedure, this will vary by doctor. Most will do the second procedure at a lower cost, especially if there is now sufficient bone to place the implant (with additional augmentation). (Editor’s Note: Please see Dental Implant Patient with Diabetes? for another discussion of this topic)

There are other concerns for diabetics who may be controlled with metformin. Recent research has shown that metformin inhibits capillary angiogenesis which can cause graft failure especially in locations where a flap or sinus membrane lies directly over an avascular graft. The normal response of a soft tissue flap or membrane that is lifted from its vascularized bony base is hypoxia This will cause the release of factors that will up regulate capillary angiogenesis which is why people can survive myocardial infarction. If metformin is on board and depending on its dosage this capillary angiogenesis is inhibited leading to necrosis of the flap or membrane and loss of graft. In well vascularized locations metformin will promote healing but in areas over avascular grafts its effect is inhibitory. This is a very recently discovered angiogenesis inhibitory effect