Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews

Abstract

Background Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. Material and Methods An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. Results We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. Conclusions Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies. Key words: Dental implants, diabetes, systematic review, meta-analysis, survival rate.

Systematic review on diabetes mellitus and dental implants: an update

“…In five studies, no clear conclusion could be drawn from the data obtained, so that the question of an increased risk was not answered [ 10 , 25 , 33 , 43 , 64 ]. However, the available aggregated literature consistently concluded that diabetes mellitus represents a risk factor for the development of peri-implant inflammation, although most studies point to a lack of high-quality and long-term studies on this research area [ 8 , 50 , 51 , 54 – 56 , 58 , 60 – 63 ].…”

Influence of Diabetes on Implant Failure and Peri-Implant Diseases: A Retrospective Study

“…As for implant survival rates, the present study did not find any association with diabetes. A recent review published by Oliveira-Neto et al in 2019 [5] came to the same conclusion, reporting that diabetes did not affect implant survival rate in two meta-analyses of high methodological quality [18,19]. Chrcanovic et al [18] analyzed a total of 604 subjects (49 diabetic, 555 non-diabetic) and reported an RR of 1.07, while Moraschini and Barboza [19] analyzed a total of 2334 subjects (802 diabetic, 1532 non-diabetic), with an RR of 1.43 and 3.65 for type 1 and type 2 DM, respectively; it must be noted that in all the included studies diabetes was under control at the time of the surgery.…”

“…While diabetes has been proven as an important risk factor for periodontitis, its association with peri-implant diseases has not been fully explored, and the existing literature reports controversial results. Some hypotheses of how diabetes could interfere with implant success have been formulated, and these include: the suppression of osteoblastic differentiation, proliferation and activity, deficits in the healing process, and the alteration of the immune response [5].…”

Methodological quality of systematic reviews in dentistry including animal studies: a cross-sectional study

“…Multiple recent publications have addressed the topic of methodological quality of systematic reviews in dentistry [ 10 ] including the fields of neuromuscular dentistry [ 11 ], implant dentistry [ 12 – 14 ], periodontology [ 15 , 16 ], orthodontics [ 17 ], endodontics [ 18 ] and oral and maxillofacial surgery [ 19 ]. In these studies, there was substantial lack of adherence to considered critical methodological quality domains [ 8 ].…”