Evaluation of the Tissue Immune Microenvironment in the Diabetic Patients with Dental Implant

Long-term hyperglycemia in people with diabetes very frequently leads to damage and/or dysfunction of many tissues and organs of the human body, causing increased clinical morbidity. There is, however, an increased correlation between glycemic control and the onset of these consequences and in particular microvascular and macrovascular complications. The results of some studies have suggested that diabetes exerts an influence on the failure rates of implants compared to non-diabetic patients. One study demonstrates that HbA1c level (higher or lower than the threshold of 8.1) also influences the survival rate of dental implants. Biopsy fragments from 8 consecutive patients who had a titanium dental implant as well as diabetes were included in our study. The control group was represented by 4 patients with dental implants and who did not have diabetes. After the histological processing of the tissues, cell counts of CD4, CD8, CD20 and CD3 lymphocytes were performed by using QuPath. The findings characterize the composition of lymphocyte populations in the oral mucosa surrounding dental implants. In diabetic patients, poor glycemic control has been associated with a decreased CD4/ CD8, contrary to our findings in tissue. The decreased number of CD20 positive lymphocytes could be associated with the dysfunction of humoral immunity generally observed in patients with diabetes. In our study, a 2.5 x higher value of TCD4+ lymphocytes was noted compared to the average of TCD8+ type lymphocytes. These results support the involvement of these types of inflammatory cells in the potimplant bone healing processes. This process starts on the 10th day post-implant. Different studies raise, in these cases, the question of innate immune response vs adaptive immune response. Suppression of processes induced by CD8+ lymphocytes is associated with stimulation of bone formation. Our results support this hypothesis.