Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Biological markers around immediately placed titanium implant in the extraction socket of diabetic and insulin-treated rat maxilla

  • Park, Su-Hyun (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University of Korea) ;
  • Heo, Hyun-A (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University of Korea) ;
  • Lee, Won (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University of Korea) ;
  • Pyo, Sung-Woon (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University of Korea)
  • Received : 2012.03.12
  • Accepted : 2012.05.18
  • Published : 2012.08.30
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Abstract

Objectives: Dental implants installation in patients with diabetes remains controversial as altered bone healing around implants has been reported. And little is known about the biological factors involved in bone healing around implants. The present study aimed to investigate the biological markers around immediately placed implants in rats with controlled and uncontrolled diabetes. Materials and Methods: Twenty rats (40 sites) were divided into the control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. Two threaded titanium alloy implant ($1.2{\times}3mm$) were placed in the extraction socket of the both maxillary first molars and allowed for healing. Bone blocks including implant were harvested at 3 days, 1, 2 and 4 weeks. The levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-${\beta}1$, osteocalcin (OC) and osteonectin (ON) were measured in the peri-implant osseous samples by RT-PCR. Results: The BMP-4 level increased immediately in all groups by day 3, then decreased abruptly in the control and the insulin-treated groups. However, by week 4, all groups showed mostly the same amount of BMP-4 expression. The level of TGF-${\beta}1$ also instantly increased by day 3 in the insulin-treated group. This level elevated again reaching the same values as the control group by week 4, but was not as high as the diabetic group. In addition, the expression of OC and ON in the control and insulin-treated groups was higher than that of the diabetic group at 2 weeks and 4 weeks, indicating active bone formation in these groups. Conclusion: The immediate placement of titanium implants in the maxilla of diabetic rat led to an unwanted bone healing response. Conclusively, the results of this study suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.

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References

  1. Lazzara RJ. Immediate implant placement into extraction sites: surgical and restorative advantages. Int J Periodontics Restorative Dent 1989;9:332-43.
  2. Wagenberg BD, Ginsburg TR. Immediate implant placement on removal of the natural tooth: retrospective analysis of 1,081 implants. Compend Contin Educ Dent 2001;22:399-404.
  3. Becker W, Goldstein M. Immediate implant placement: treatment planning and surgical steps for successful outcome. Periodontol 2000 2008;47:79-89.
  4. Marder MZ. Medical conditions affecting the success of dental implants. Compend Contin Educ Dent 2004;25:739-42.
  5. Oczakir C, Balmer S, Mericske-stern R. Implant-prosthodontic treatment for special care patients: a case series study. Int J Prosthodont 2005;18:383-9.
  6. McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 1995;9:1-9.
  7. Kotsovilis S, Karoussis IK, Fourmousis I. A comprehensive and critical review of dental implant placement in diabetic animals and patients. Clin Oral Implants Res 2006;17:587-99.
  8. Mombelli A, Cionca N. Systemic diseases affecting osseointegration therapy. Clin Oral Implants Res 2006;17 Suppl 2: 97-103.
  9. Olson JW, Shernoff AF, Tarlow JL, Colwell JA, Scheetz JP, Bingham SF. Dental endosseous implant assessments in a type 2 diabetic population: a prospective study. Int J Oral Maxillofac Implants 2000; 15:811-8.
  10. van Steenberghe D, Jacobs R, Desnyder M, Maffei G, Quirynen M. The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage. Clin Oral Implants Res 2002;13:617-22.
  11. Fiorellini JP, Chen PK, Nevins M, Nevins ML. A retrospective study of dental implants in diabetic patients. Int J Periodontics Restorative Dent 2000;20:366-73.
  12. Morris HF, Ochi S, Winkler S. Implant survival in patients with type 2 diabetes: placement to 36 months. Ann Periodontol 2000;5:157-65.
  13. Nevins ML, Karimbux NY, Weber HP, Giannobile WV, Fiorellini JP. Wound healing around endosseous implants in experimental diabetes. Int J Oral Maxillofac Implants 1998;13:620-9.
  14. Fiorellini JP, Nevins ML, Norkin A, Weber HP, Karimbux NY. The effect of insulin therapy on osseointegration in a diabetic rat model. Clin Oral Implants Res 1999;10:362-8.
  15. Mccracken MS, Aponte-wesson R, Chavali R, Lemons JE. Bone associated with implants in diabetic and insulin-treated rats. Clin Oral Implants Res 2006;17:495-500.
  16. Takeshita F, Iyama S, Ayukawa Y, Kido MA, Murai K, Suetsugu T. The effects of diabetes on the interface between hydroxyapatite implants and bone in rat tibia. J Periodontol 1997;68:180-5.
  17. Siqueira JT, Cavalher-Machado SC, Arana-Chavez VE, Sannomiya P. Bone formation around titanium implants in the rat tibia: role of insulin. Implant Dent 2003;12:242-51.
  18. Shirakura M, Fujii N, Ohnishi H, Taguchi Y, Ohshima H, Nomura S, et al. Tissue response to titanium implantation in the rat maxilla, with special reference to the effects of surface conditions on bone formation. Clin Oral Implants Res 2003;14:687-96.
  19. Shyng YC, Devlin H, Ou KL. Bone formation around immediately placed oral implants in diabetic rats. Int J Prosthodont 2006; 19:513-4.
  20. Hasegawa H, Ozawa S, Hashimoto K, Takeichi T, Ogawa T. Type 2 diabetes impairs implant osseointegration capacity in rats. Int J Oral Maxillofac Implants 2008;23:237-46.
  21. Kwon PT, Rahman SS, Kim DM, Kopman JA, Karimbux NY, Fiorellini JP. Maintenance of osseointegration utilizing insulin therapy in a diabetic rat model. J Periodontol 2005;76:621-6.
  22. Matin K, Senpuku H, Hanada N, Ozawa H, Ejiri S. Bone regeneration by recombinant human bone morphogenetic protein-2 around immediate implants: a pilot study in rats. Int J Oral Maxillofac Implants 2003;18:211-7.
  23. Goodman WG, Hori MT. Diminished bone formation in experimental diabetes. Relationship to osteoid maturation and mineralization. Diabetes 1984;33:825-31.
  24. Verhaeghe J, Suiker AM, Nyomba BL, Visser WJ, Einhorn TA, Dequeker J, et al. Bone mineral homeostasis in spontaneously diabetic BB rats. II. Impaired bone turnover and decreased osteocalcin synthesis. Endocrinology 1989;124:573-82.
  25. Schenk RK, Buser D. Osseointegration: a reality. Periodontol 2000 1998;17:22-35.
  26. Reddi AH. Bone morphogenetic proteins: from basic science to clinical applications. J Bone Joint Surg Am 2001;83-A Suppl 1:S1-6.
  27. Katagiri T, Takahashi N. Regulatory mechanisms of osteoblast and osteoclast differentiation. Oral Dis 2002;8:147-59.
  28. Ahrens M, Ankenbauer T, Schröder D, Hollnagel A, Mayer H, Gross G. Expression of human bone morphogenetic proteins-2 or -4 in murine mesenchymal progenitor C3H10T1/2 cells induces differentiation into distinct mesenchymal cell lineages. DNA Cell Biol 1993;12:871-80.
  29. Ogawa T, Sukotjo C, Nishimura I. Modulated bone matrix-related gene expression is associated with differences in interfacial strength of different implant surface roughness. J Prosthodont 2002;11:241-7.
  30. Carrington JL, Roberts AB, Flanders KC, Roche NS, Reddi AH. Accumulation, localization, and compartmentation of transforming growth factor beta during endochondral bone development. J Cell Biol 1988;107:1969-75.
  31. Horner A, Kemp P, Summers C, Bord S, Bishop NJ, Kelsall AW, et al. Expression and distribution of transforming growth factor-beta isoforms and their signaling receptors in growing human bone. Bone 1998;23:95-102.
  32. Noda M, Camilliere JJ. In vivo stimulation of bone formation by transforming growth factor-beta. Endocrinology 1989;124:2991-4.
  33. Rosier RN, O'keefe RJ, Hicks DG. The potential role of transforming growth factor beta in fracture healing. Clin Orthop Relat Res 1998;355 Suppl:S294-300.
  34. Marcelli C, Yates AJ, Mundy GR. In vivo effects of human recombinant transforming growth factor beta on bone turnover in normal mice. J Bone Miner Res 1990;5:1087-96.
  35. Seto H, Aoki K, Kasugai S, Ohya K. Trabecular bone turnover, bone marrow cell development, and gene expression of bone matrix proteins after low calcium feeding in rats. Bone 1999;25:687-95.
  36. Ogawa T, Nishimura I. Genes differentially expressed in titanium implant healing. J Dent Res 2006;85:566-70.
  37. Westerlind KC, Wronski TJ, Evans GL, Turner RT. The effect of long-term ovarian hormone deficiency on transforming growth factor-beta and bone matrix protein mRNA expression in rat femora. Biochem Biophys Res Commun 1994;200:283-9.
  38. Boskey AL, Maresca M, Ullrich W, Doty SB, Butler WT, Prince CW. Osteopontin-hydroxyapatite interactions in vitro: inhibition of hydroxyapatite formation and growth in a gelatin-gel. Bone Miner 1993;22:147-59.