Dental implant outcomes in patients with diabetes mellitus: a systematic review

OBJECTIVE: This systematic review aimed to evaluate the outcomes of dental implant therapy in patients with diabetes mellitus (DM), focusing on survival rates, peri-implant health, the impact of glycemic control, and the efficacy of adjunctive therapies. METHODS: Following PRISMA 2020 guidelines, a comprehensive search of multiple databases was conducted up to July 2025. Included studies reported on implant outcomes in diabetic patients or relevant animal models. The methodological quality of the included studies was assessed using appropriate tools such as CONSORT, STROBE, and ARRIVE checklists. RESULTS: Out of 3,637 identified records, 54 studies were included. While overall implant survival rates in diabetic patients were often high (> 90-95%), diabetes, particularly when poorly controlled (HbA1c > 8%), was consistently associated with significantly worse outcomes. These included greater marginal bone loss (MBL), higher probing depths, increased bleeding on probing, and elevated levels of peri-implant inflammatory markers (e.g., IL-6, TNF-α) compared to non-diabetic controls. Well-controlled diabetics (HbA1c ≤ 7%) often had outcomes comparable to non-diabetics. Adjunctive antimicrobial photodynamic therapy (aPDT) proved effective in improving clinical parameters and reducing inflammation. Preclinical studies on advanced implant surfaces, such as bioactive coatings and 3D-printed porous structures, showed enhanced osseointegration in diabetic conditions. CONCLUSION: Dental implant therapy can be successful in well-controlled diabetic patients. However, poor glycemic control significantly increases the risk of peri-implant complications and failure. Successful long-term outcomes necessitate stringent glycemic control, meticulous treatment planning, aggressive maintenance, and the potential application of advanced adjunctive therapies.