Increasing the efficiency of osseointegration in dental implantation in patients with diabetic osteopathy by remodeling bone tissue and intensifying its density.

Abstract

The purpose of the study was to increase the effectiveness of osseointegration of implants in dental implantation in patients with rapidly progressing generalized periodontitis combined with diabetic osteopathy by restoring normal remodeling of bone tissue and intensifying its density. The study included 84 patients aged 30 to 50 years (average 41.9±2.36 years) with type 2 diabetes mellitus associated with generalized periodontitis, among them 56 women and 28 men and 19 volunteer donors without periodontal and detected somatic pathology, identical by gender and age. Surgical intervention for the installation of dental implants was performed in 3 groups of patients identical by gender and age: I, II and III groups. Groups I and II included 52 patients (26 patients in each) with rapidly progressing generalized periodontitis, with type 2 diabetes, complicated by systemic osteoporosis, who differed only in the prescribed treatment complex. Group III was formed by patients with a similar pathology of periodontal tissues, but without background diabetic osteopathy (32 patients), who received an identical treatment complex with patients in Group II. During the surgical intervention, 282 dental implants were installed: 92 implants in group I patients, 89 implants in group II, and 101 dental implants in group III. At the same time, we strove to ensure that the percentage of the performed operations was approximately the same. The analysis of the obtained data of laboratory studies showed that in patients with diabetic osteopathy with rapidly progressing periodontitis and rapidly progressing generalized periodontitis without background pathology, a deeper imbalance of the processes of bone remodeling with high level of both – bone resorption and osteogenesis is observed, which causes acceleration of the destruction of periodontal bone tissue and their loss. At the same time, it was found that with a complex and correct selection of antiresorptive therapy, the level of markers of bone metabolism approaches the norm, which is positively reflected in the dynamics and frequency of osseointegration of dental implants. Our research and received data from laboratory studies showed that in patients with rapidly progressing generalized periodontitis with and without diabetic osteopathy, there is an inhomogeneity and imbalance in the functioning of bone remodeling, which negatively affects the process of osseointegration of dental implants and requires a complex approach in the selection of antiresorptive therapy. Inclusion in the protocol of dental implantation of recombinant morphogenetic protein in patients with diabetes with osteopathology leads to completion of osseointegration of dental implants in the term up to 3 months, and monotherapy with  ossein-hydroxyapatite complex in patients with rapidly progressing generalized periodontitis has a similar effect on the osseointegration process – it accelerates the recovery of bone tissue around dental implants.