Mohammad D. Al Amri Sergio Varela Kellesarian Abdulaziz A. Al-Kheraif Hans Malmstrom Fawad Javed Georgios E. Romanos Effect of oral hygiene maintenance on HbA1c levels and peri-implant parameters around immediately-loaded dental implants placed in type-2 diabetic patients: 2 years follow-up Authors’ affiliations: Mohammad D. Al Amri, Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia Sergio Varela Kellesarian, Hans Malmstrom, Fawad Javed, Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA Abdulaziz A. Al-Kheraif, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia Georgios E. Romanos, Department of Periodontology, School of Dental Medicine, Stony Brook University, New York, NY, USA and Department of Oral Surgery and Implant Dentistry, Dental School Frankfurt, Frankfurt, Germany Corresponding author: Georgios E. Romanos, Professor Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794, USA Tel.: +1 (631) 632-8755 Fax: +1 (631) 632-8670 e-mail: Georgios.romanos@stonybrook.edu Key words: immediately loaded implant, oral hygiene, peri-implant, type 2 diabetes mellitus Abstract Objective: The aim of the present 2-year follow-up study was to assess the effect of oral hygiene maintenance on hemoglobin Alc (HbA1c) levels and peri-implant parameters around immediately- loaded dental implants placed in type-2 diabetic patients with varying glycemic levels. Material and methods: Ninety-one individuals were divided into three groups. In group 1, 30 systemically healthy individuals were included (HbA1c < 6%). Patients in group 2 and 3, comprised of 30 patients with T2DM (HbA1c 6.1–8%); and 31 patients with T2DM (HbA1c 8.1–10%) respectively. In all groups, patients received immediately loaded bone level implants. All participants were enrolled in a 6 monthly periodontal/peri-implant maintenance program. Peri- implant bleeding on probing (BOP), probing depth (PD), and marginal bone loss (MBL) were measured at 6, 12, and 24 months of follow-up. Results: Mean preoperative HbA1c levels in patients in groups 1, 2, and 3 were 4.5%, 6.8%, and 8.7% respectively. In group-1, there was no significant difference in HbA1c levels at all follow-up durations. Among patients in groups 2 and 3, there was a significant decrease in HbA1c levels at 24-months follow-up than 6-months follow-up. At 6 months follow-up, BOP, PD, and MBL were significantly higher among patients in group-3 than group-1. At 12 and 24 months follow-up, there was no significant difference in BOP, PD, and MBL in all groups. Conclusions: Oral hygiene maintenance reduces hyperglycemia and peri-implant inflammatory parameters around immediately loaded dental implants placed in type 2 diabetic patients. Placement of dental implants in patients with diabetes mellitus (DM) was previously avoided due to the increased risk of delayed healing, microvascular complications, tissue damage and infections in these patients (Delamaire et al. 1997; Ebersole et al. 2008; Javed & Romanos 2009). However, under optimal glycemic control, dental implants can osseointegrate and remain functionally and esthetically stable in patients with DM in a manner similar to non-diabetic individu- als (Javed & Romanos 2009; Fenner et al. 2015; Hoeksema et al. 2015). It has been pro- posed that optimal glycemic control levels may help to improve the function of osteo- blasts, and retard the progression of periodon- tal inflammation and bone loss (Aguilar- Salvatierra et al. 2015; Ghiraldini et al. 2015). Glycosylated hemoglobin Alc (HbAlc) is a form of stable glycosylated hemoglobin, the product of a slow and largely irreversible reaction produced during the red blood cell life cycle. For more than four decades, mea- surement of HbAlc levels has been acknowl- edged as a precise approach to determine and monitor glycemic status in diabetic patients as it reflects average blood glucose levels dur- ing the previous 2–3 months (Koenig et al. 1976). It has been reported that non-surgical peri- odontal therapy (NSPT) improves periodontal status and lower glycemic levels in patients with type-2 diabetes mellitus (T2DM) (Rodrigues et al. 2003; Al-Zahrani et al. 2009; Koromantzos et al. 2011; Auyeung et al. 2012; Sgolastra et al. 2013) by reducing the systemic burden of inflammatory media- tors (such as interleukin-1beta and tumor necrosis factor-alpha) that aggravate the existing metabolic disorder in patients with Date: Accepted 26 October 2015 To cite this article: Al Amri MD, Kellesarian SV, Al-Kheraif AA, Malmstrom H, Javed F, Romanos GE. Effect of oral hygiene maintenance on HbA1c levels and peri-implant parameters around immediately-loaded dental implants placed in type-2 diabetic patients: 2 years follow-up. Clin. Oral Impl. Res. 00, 2016, 1–5 doi: 10.1111/clr.12758 © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1