J Korean Assoc Oral Maxillofac Surg.  2012 Aug;38(4):204-211. 10.5125/jkaoms.2012.38.4.204.

Biological markers around immediately placed titanium implant in the extraction socket of diabetic and insulin-treated rat maxilla

• Park S
• Heo HA
• Lee W
• Pyo SW

• KMID: 2189627
• DOI: http://doi.org/10.5125/jkaoms.2012.38.4.204

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 (1.2x3 mm) 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)-beta1, 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-beta1 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.

Keyword

Type 1 diabetes; Dental implant; Insulin; Biological markers

MeSH Terms

Alloys
Animals
Biological Factors
Biomarkers
Bone Morphogenetic Proteins
Dental Implants
Humans
Insulin
Maxilla
Molar
Osteocalcin
Osteogenesis
Osteonectin
Rats
Streptozocin
Titanium
Transforming Growth Factor beta1
Transforming Growth Factors
Alloys
Biological Factors
Bone Morphogenetic Proteins
Dental Implants
Insulin
Osteocalcin
Osteonectin
Streptozocin
Titanium
Transforming Growth Factor beta1
Transforming Growth Factors

Figure

• 

  Fig. 1 Schematic design of the experiment (A) and titanium implants placed in the extraction socket of both maxillary first molars (B).

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  Fig. 2 Representative RT-PCR. RT-PCR products run on an agarose gel. The ratio of the fluorescence of each RT-PCR product to that of GAPDH was calculated. Lane 1-5: product of 3 days, lane 6-10: 1 week, lane 11-15: 2 week and lane 16-20: 4 week, respectively. (BMP: bone morphogenetic protein, TGF: transforming growth factor, GAPDH: glyceraldehyde 3-phosphate dehydrogenase)

• 

  Fig. 3 BMP-4 expression pattern in the surrounding bone of immediately placed implant in the control, insulin-treated and diabetic rats at different healing phases by reverse transcription polymerase chain reaction analysis. (BMP: bone morphogenetic protein, DM: diabetes, DMC: diabetes controlled, C: controlled)

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  Fig. 4 TGF-β1 expression pattern in the surrounding bone of immediately placed implant in the control, insulin-treated and diabetic rats at different healing phases by reverse transcription polymerase chain reaction analysis. (TGF: transforming growth factor, DM: diabetes, DMC: diabetes controlled, C: controlled)

• 

  Fig. 5 Osteocalcin expression pattern in the surrounding bone of immediately placed implant in the control, insulin-treated and diabetic rats at different healing phases by reverse transcription polymerase chain reaction analysis. (DM: diabetes, DMC: diabetes controlled, C: controlled)

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  Fig. 6 Osteonectin expression pattern in the surrounding bone of immediately placed implant in the control, insulin-treated and diabetic rats at different healing phases by reverse transcription polymerase chain reaction analysis. (DM: diabetes, DMC: diabetes controlled, C: controlled)

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