title: Crestal Bone Loss under Delayed Loading of Full Thickness Versus Flapless Surgically Placed Dental Implants in Controlled Type 2 Diabetic Patients: A Parallel Group Randomized Clinical Trial.
abstract: OBJECTIVE
  To compare crestal bone loss around dental implants using a delayed loading protocol. Bone loss was compared in patients following conventional full thickness flap and flapless surgery in controlled type 2 diabetic patients.
  
  
  METHODS
  Eighty-eight type 2 diabetic patients satisfying predetermined inclusion and exclusion criteria were selected for this single center, parallel group study after obtaining institutional review board approval and informed consent. These patients were randomly divided into two groups. Group I consisted of patients undergoing full thickness flap surgery for implant placement, and group II consisted of patients undergoing flapless surgery for implant placement. The mean age, duration of diabetes, glycosylated hemoglobin levels, and male-to-female ratio in both groups were matched and compared statistically. Dental implants were placed followed by delayed loading (4 months) in both groups. Crestal bone loss was assessed with intraoral periapical radiographs with the help of computer software (DBSWIN viewer). Actual implant length acted as the radiographic index, and implant-abutment junctions were used as a reference point for all measurements. Mesial and distal bone levels at baseline, 6, and 12 months post implant placement of the two groups were determined. Mesial and distal crestal bone loss from baseline to 6 and 12 months were calculated and compared with Tukey test using SPSS v15.0 statistical analysis software.
  
  
  RESULTS
  Tukey test revealed similar (not statistically different) mean mesial crestal bone loss between the two groups after 6 months (0.47 ± 0.08 mm vs. 0.36 ± 0.13 mm, p = 0.576) and after 12 months (1.56 ± 0.25 mm vs. 1.50 ± 0.22 mm, p = 0.891). The mean distal bone loss resulting between the two groups was not statistically different at 6 months (0.44 ± 0.08 mm vs. 0.35 ± 0.12 mm, p = 0.687) and at 12 months (1.57 ± 0.23 mm vs. 1.61 ± 0.22 mm, p = 0.947).
  
  
  CONCLUSIONS
  The results of this clinical randomized control trial indicated that in controlled type 2 diabetic patients, levels of crestal bone loss around dental implants placed following conventional full thickness flap surgery was comparable to crestal bone loss around dental implants placed with the flapless surgical technique. More clinical studies are required regarding controlled type 2 diabetics with larger sample sizes, for long time periods to obtain more predictable results.
authors.affiliation: Department of Prosthodontics, King George's Medical University, Lucknow, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Department of Prosthodontics, King George's Medical University, Lucknow, India.
authors.forename: Kaushal Kishor
authors.initials: KK
authors.lastname: Agrawal
authors.affiliation: Department of Prosthodontics, King George's Medical University, Lucknow, India.
authors.forename: Jitendra
authors.initials: J
authors.lastname: Rao
authors.affiliation: Department of Prosthodontics, King George's Medical University, Lucknow, India.
authors.forename: Mohd
authors.initials: M
authors.lastname: Anwar
authors.affiliation: Department of Prosthodontics, King George's Medical University, Lucknow, India.
authors.forename: Habib Ahmed
authors.initials: HA
authors.lastname: Alvi
authors.affiliation: Department of Biochemistry, King George's Medical University, Lucknow, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, India.
authors.forename: D
authors.initials: D
authors.lastname: Himanshu
mesh_terms: D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants
keywords: Crestal bone loss; dental implant; diabetes mellitus