jkaoms Journal of the Korean Association of Oral and Maxillofacial Surgeons J Korean Assoc Oral Maxillofac Surg 1225-1585 2234-5930 Korean Association of Oral and Maxillofacial Surgeons 10.5125/jkaoms.2011.37.1.30 jkaoms-37-30 Original Article Bone response around immediately placed titanium implant in the extraction socket of diabetic and insulin-treated rat maxilla KimDae-Won 1 HeoHyun-A 2 LimSang-Gyu 2 LeeWon 1 2 KimYoung-Sil 3 PyoSung-Woon 1 2 Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dental Science, The Catholic University of Korea Division of Oral and Maxillofacial Surgery, Department of Dentistry, School of Medicine, The Catholic University of Korea, Bucheon Department of Pathology, College of Medicine, Jeju National University, Jeju, Korea Sung-Woon Pyo Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, 420-717, Korea TEL: +82-32-340-2134 FAX: +82-32-340-2255 E-mail: spyo@catholic.ac.kr 01 2011 10 01 2011 37 1 30 35 28092010 17122010 20012011 Copyright © 2011 Korean Association of Oral and Maxillofacial Surgeons 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction

Dental implants are used routinely with high success rates in generally healthy individuals. By contrast, their use in patients with diabetes mellitus is controversial because altered bone healing around implants has been reported. This study examined the bone healing response around titanium implants placed immediately in rats with controlled and uncontrolled diabetes.

 Materials and Methods

Twenty rats 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. A titanium implant (1.2×3 mm) was placed in the extraction socket of the maxillary first molar and bone block was harvested at 1, 2 and 4 weeks.

 Results

Bone formation around the implants was consistently (from 1 to 4 week post-implantation) slower for the diabetic group than the control and insulin-treated group. Bone morphogenesis in the diabetic rats was characterized by fragmented bone tissues and extensive soft tissue intervention.

 Conclusion

The immediate placement of titanium implants in the maxilla of diabetic rats led to an unwanted bone healing response. These results suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.

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

Hematoxylin and eosin-stained histological sections of bone implant interface 2 weeks after implantation.(original magnification ×40) No apparent differences between the groups could be observed. A. Control group. B. Diabetic group. C. Insulin-treated group.

Hematoxylin and eosin-stained sections of bone implant interface 2 weeks after implantation.(original magnification ×200) Less organized and more cellular woven bone in sections from diabetic group is observed. A. Control group. B. Diabetic group. C. Insulin-treated group.

Hematoxylin and eosin-stained sections of bone implant interface 4 weeks after implantation.(original magnification ×40) Decreased bone apposition was observed in the diabetic group, which suggest an impaired osteoblastic function or mineralization defect. A. Control group. B. Diabetic group. C. Insulin-treated group.

Hematoxylin and eosin-stained sections of bone implant interface 4 weeks after implantation.(original magnification ×200) Calcified mature woven bone with the marked restitution of marrow can be observed in the control and insulin-treated groups. A. Control group. B. Diabetic group. C. Insulin-treated group.