Diabetes, Dental Implants and Bone Grafts…Is it Safe?

You may be reading this because you are at a diabetic in need of an extraction and bone graft or full mouth dental implants.  You are probably well aware that diabetes can cause slow healing from dental surgery or any type of surgery.  You can be at a higher risk of complications because of being a diabetic.

So how do I do dental implants and bone grafts on diabetics?  VERY Carefully!!!

bone-graft-square Diabetes affects all organ systems.  Big fluctuations in blood sugar cause your healing to be impaired.  Diabetics are prone to problems with feet, eyes and kidneys but oftentimes develop periodontal disease/gum disease which has likely led you to this point to read about implants and extractions.  I tell all my diabetic patients that you must be extremely diligent in the care of your teeth even more so than someone that does not have diabetes.  This is because you are more prone to lose them and replacing teeth with implants is more difficult than your situation… difficult but not impossible.

In these photographs I show two patients that have had similar treatment at the same 7-10 day follow-up.   I treated both patients. You can see that the patient that  has diabetes that is not well managed is healing much slower than the patient that does not have diabetes.  This is not always the case but this is a great example! 

Diabetic that is not well managed is healing much slower
Diabetic that is not well managed is healing much slower
Non-diabetic with normal healing
Non-diabetic with normal healing

Neither one of these patients had bone grafting in addition to the implants they only had four implants placed in the same area for a lower dental implant overdenture.  They are both females in their 60’s.

Hemoglobin A1c and dental implants

You are probably familiar with taking your blood sugar. These numbers need to be as low as possible in the good range.  Blood sugar testing should be routine and a very important number called the “hemoglobin A1c” gives me an idea of how well you will heal after a dental implant/bone graft procedure.

Ideally the lower the A1c number the better because that gives me an idea over the last 3 months how stable your blood sugar control is.  If the A1c and daily blood sugar readings are high, then perhaps we need to consult with your endocrinologist to get it into better health.   A1c should be lower than 8 for anything major but ideally in the 6 range

Of course your diet and lifestyle have a lot to do with diabetes control.  Sometimes just switching meds does the trick while others need to be managed with an insulin pump.

In the weeks prior and at least 4-6 weeks after a dental surgical procedure, try to be as strict is possible with your diet and diabetes control.  It is in this critical early-phase that major complications can happen and failures or infections are most likely to happen.

diabetes-square I use some special techniques to try to help my diabetic patients heal as quickly as possible.  For the last 19 years or so, I have used the patient’s own blood to make special concentrated versions that carry growth factors, which aid in the healing process.  Also a strict aseptic/sterile technique of placing implants, bone grafts helps reduce your chance of infection by having a very clean environment to start with.  Antibiotics are almost always necessary often in the IV and given by mouth for 7-10 days afterwards and occasionally longer.

Keep in mind that some implants and bone grafts are **far more** complicated than others.  The more complex the situation, the higher the risk of having some sort of complications.   For example, full mouth dental implants and block bone grafting is more complex than a single socket graft.

I would suggest that you work with a very skilled and experienced provider who has done hundreds of implants successfully on diabetics to figure out what is right for you.  Be very open and honest with your implant dentist so you can safely treated and have it done right the first time.  You can be succesfully treated!  Type 2 diabetes is better than Type 1 but both can be treated. You must be managed a bit differently to prevent implant failure and bone loss.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

21 thoughts on “Diabetes, Dental Implants and Bone Grafts…Is it Safe?”

  1. Hello. I had visited a new dentist in the office I usually go to and I have noticed she was rather careless with many things including this. I had gestational diabetes, I was never tested to see if it developed into type 2 diabetes. My dentist knew this and basically said it wasn’t important. Not once did she mention getting my A1c checked.

    Furthermore, I went in for a crown and a filling replacement that my original dentist put last on my treatment plan because they posed the least risk. The new dentist, in a major rush to be on time to her next appointment seemed to be more focused on looking at her schedule while drilling my teeth. She ended up drilling into them to the point of them needing to be pulled. I was in no pain when I went in for this appointment, no infection was present and the dentist did not take X-rays of the teeth before drilling away. I am still not convinced the extractions were needed. She was unable to successfully numb the teeth she extracted, but ended up somehow giving me 6 injections, numbing my face all the way to my eye so I could not blink but my teeth never became numb. One of the shots about sent me flying out of the chair as it felt like I was being electrocuted. 2 months later I still have numbness in my face and it is becoming increasingly hard to speak.

    Regarding my graft treatment, she placed a bone graft after the extraction that has been trouble from the start. I have never been in so much pain in my life. The first few weeks healing were excruciating. To put it into perspective, giving birth to twins was not nearly as painful as the healing process of the bone graft site. The stitches came loose days after as well. I had gone back into the office several times and they don’t offer any solution that is actually helping the gums heal. They are healing incredibly lowly and the gums around the surrounding teeth are receding. I had 2 bone grafts, one is much narrower than the other and I was already told by a second dentist in a different office my implants could not be placed. They have not healed flat and there are still blisters on the gums. Could this be from a high A1c? It has only been an couple months, is there a chance the bone volume increases? Is the dentist who did this at all responsible for this? This dental office nearly impossible to get a hold and I just really want to know what I can do to get this to heal before it’s too late. I don’t know what to do. If you have any advice I would greatly appreciate it.

    Reply
  2. Greetings Dr. Amin,
    Words can not express enough my respect to you for your compassion in bringing hopes. Your efforts in allowing all of us to communicate with you is deeply appreciated. THANK YOU!
    A newly diagnosed type 2 relative (40-ish) with A1c at 12(+)%, currently taking metformin 1000 mg, twice a day with a future appt. made to work with an endocrinologist has many missing front teeth (came off with failed crowns, failed implant and other teeth decays that Interim caries arresting meds have not seemed to be helpful.
    1. Is he a candidate for any of the procedures in your office?
    2. If he is not, per your recommendation to a previous high A1c post, would you please recommend offices that work with diabetic patients around the Northern CA?
    3. Are temporary dentures suitable for the time being?
    Thanks again,
    JL

    Reply
    • Hi JL,
      Thank you for your kind words.
      With an A1c that high you are asking for TROUBLE.

      I would focus on gum health only for now. basic crowns and fillings after the gum condition is stable.

      No implants yet until a1c drops into the 6 or 7 range.

      Some pts can be treated in the 8 range but it really should be simple surgery not full arch replacement!

      Temp dentures could work for now for sure but that is a very low quality of life. 😞

      This would be more ideal:

      https://burbankdentalimplants.com/all-on-4-full-mouth-dental-implants/

      What do you think?

      Reply
      • Hi Dr. Amin, The Tooth Angel *_*
        The link of the all on 4/5 was so well presented and the relative now has a goal to reach. I kept thinking and deeply moved by how you have enriched the lady’s life….Beautiful!
        Thank you for sensing the urgency of our anxiety with your prompt reply. The direction is clear and now we have a good base to move forward.
        Questions please:
        1. After the diabetes patient with the controlled 7% gets the
        all on 4 procedure done, later the A1c goes back up, what happens?
        2. What’s your estimate time of gum healing for type 2 patients?
        Blessings to you, yours and your staff,
        JL
        P.S.
        Sharing experience with the readers: when selecting surgeon(s) to do (especially) major/massive dental works, please do NOT just base on or trust how long you have worked with the dental office, but to truly do your research to understand if you are briefed clearly the involvements of before and after…etc.

        Reply
        • Aww…thank you for your kindness. The world needs more people like you 😊

          1. After the diabetes patient with the controlled 7% gets the
          all on 4 procedure done, later the A1c goes back up, what happens?

          This can make the implants lose bone and fail….just like the teeth did!

          2. What’s your estimate time of gum healing for type 2 patients?

          Depends on too many factors but basic healing takes just a few days while full integration of the implants to the bone os 4-6 months.

          Reply
          • Greetings Dr. Amin,
            Trust this message finds you and yours well.
            I have updates to our previous communications in March.
            My 41 years old relative since then has been working with an endocrinologist who started him on Ozenpick (now increased to 1 mg weekly) in addition to Metformin ER he has already taken (one tablet of 1000 mg with breakfast and one tablet with dinner. Along with some swimming/cardio tapes and more careful diet, his 3 month A1c test today has an very encouraging improvement, dropping from 12.7 to 10.8%.
            I understand all his teeth has decay and will eventually need to be extracted. The extractions of them simple teeth #18,19,29,30 and 31 were done on 4/12 with the dentist’s comment of good blood supply (seemed like a favorable situation with diabetes condition – pardon me for interpreting what I don’t really understand it all). They all healed quite well.

            Please assist with the questions:
            1. Does the above extractions with good healing shed light for the healing for the rest of more challenging teeth extractions? Implants?
            2. Soon or near future is a very suitable timing to meet and consult with you for options,
            What do you think?
            – –
            P.s. A digital pano view sent to info…. Link.

          • Great news and a very clever way for me to have seen the x-ray.

            1. Does the above extractions with good healing shed light for the healing for the rest of more challenging teeth extractions? Implants?

            Great question. I would keep waiting. 10.8 is way too high for complex stuff. Extractions will ALWAYS heal better than implants. Implants are not alive so they require many more things to be in order for them to heal. Blood supply is very important, but only one of many factors

            2. Soon or near future is a very suitable timing to meet and consult with you for options,
            What do you think?

            I would wait until A1c is about 7-7.5 or hopefully even better!

            What is your first name JL?

            Dr. Amin 😊

          • Morning Dr. Amin,
            In response to your 6/9 post:
            Your advice and comments are well taken.
            THANK YOU VERY MUCH!
            I am curious about why high numbers of oral surgeons do not seem to critique much about high A1c red flags prior to procedures (including implants). Perhaps that is one of the high implant failed outcome in the long run for diabetes without being mindfully screened prior and proper self management afterward.
            For some oral surgeons, patients who smoke, seem to be their most concern.
            So much to learn : )
            Thanks again and have a wonderful weekend,
            Jane

  3. I’m age 70 and Type II diabetic with very high A1C usually about 12.1. I’ve been as low as 10.1. I’ve also had past heart attack about 5 years ago. With my teeth falling out and perhaps 8 remaining, I MUST get all pulled and replaced. I’d prefer to go all on 4’s permanent for the lower with conventional upper denture.

    Still, I’m extremely worried about implant failure. My dentist has told me I’m at greater risk, but permanent implants are very possible. I need to make a decision on going with merely conventional lower dentures (much cheaper) or 4 permanent implants with the the zirconia (?) teeth.

    My fear is failing implants — including medical bills that I don’t suspect would be covered by Medicare. If infection would occur, I don’t know if Medicare (plus my supplement) would cover those expenses. What type warranty should I expect from a provider??? Any comments appreciated.

    Reply
    • Your hemoglobin A1c is dangerously high. Even in the most skilled of hands, an A1c of 8-9 would be pushing it for a procedure as substantial as a full mouth dental implant replacement. Your fear of failure is real.Your fear of failure is real. I personally would suggest you get in the hands of a very good endocrinologist before even attempting any of these procedures. Some people require an insulin pump in order to get better control even though they are only type II diabetic.

      Reply
    • It is important that you go to the dentist. Your teeth effect your diabetes and your diabetes affects your teeth. The more you avoid the worse it gets! You can do this! 😉

      Reply
  4. I am a Type 1 diabetic and was informed today that the rebuilding of my jaw bone is basically impossible due to the severity of my bone loss. I call BS since it was the suggested for me to get bridges on the sections where it has been determined I will lose teeth. My concerns arose due to what will the bridges connect to or even fit properly with such bone loss. Help!!!

    Reply
  5. Your blog is so useful-thank you for this service.

    I broke my front tooth 40+ years ago and had 2 crowns and a root canal over the years. After 20 years, the most recent crown came off and dentist said I needed an implant. In preparation, he did a tooth extraction and bone graft 2 1/2 weeks ago. No antibiotics were provided. I got a slight infection and dentist had me use antibiotic mouth wash for a week. 4 days ago, he adjusted my temporary as I was in some pain from it.

    Last night, I took out the temporary to sleep. My front gums above the surgical area were bleeding and are very red and very “mushy”. I’ve not been in pain the last few days even with temporary in. I am a pre-diabetic. Is this “mushiness” normal? I’d hate to go back to the dentist for a 4th time in 3 weeks if this is a normal condition. I’ve not been able to find anyone describing this condition and am so anxious something else has gone wrong that I didn’t sleep at all.

    Reply
  6. Hi ,I am always afraid that I will lose my teeth. For this ,my whole day is depressed .doctor said that I need to be surgery in almost all teeth . But I am diabetic patients . That’s why I’ am afraid of surgery .what am I doing ?

    Reply
    • I treat patients with diabetes all the time. Keep in mind that diabetes can lead to tooth loss. Also the reverses true and that gum disease can worsen the diabetes.

      Reply
  7. Hi , I am diabetic patient . So I am scare this sugary .I like to know that any kind of treatment for safe my teeth without surgery? Like home treatment ?

    Reply
  8. Reading your article leads me to believe that a three-unit bridge would be better for me than an implant. I had tooth #25 removed recently, and both adjacent teeth have been crowned. I had some bone loss in the socket because #25 was fractured, allowing bacteria to enter with subsequent (mild) infection over the last few months. I am Type II, and my last A1C was 6.1

    Reply

Leave a Comment