Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Review: Correlation Between Diabetes Mellitus and

Residual Ridge Resorption
Dr. M. Vijay Anand, M.D.S B. S. Gayathri, Junior Resident
Professor, Department of Prosthodontics, Thaimoogambigai Department of Prosthodontics, Thaimoogambigai Dental
Dental College and Hospital Chennai-600107 College and Hospital Chennai-600107

Abstract:- Diabetes mellitus is a disease resulting from compared with upper jaw (maxilla), the ratio 4:1
impaired insulin availability in the body leading to mandibular to maxillary resorption .(9)Factors
increased blood glucose which is called as type 1 diabetes affecting RRR are both systemic and local factors.
mellitus,or varying degree of insulin resistance or unable systemic fact ors are: nutritional in sufficiency,
to use the available insulin by the body is called type 2 impaired hormonal production , bone disorders,
diabetes mellitus. Residual ridge resorption is a some renal diseases, uses of drugs, constant
progressive disease which is not a reversible process that hormonal changes in women etc. (10) .some of the
occurs in every patient and itsone of the main cause for local fact ors that leadingRRR are lack of denture
complete denture failures. Uncontrolled diabetes is one retention and stability, constant pressure, incorrect
of the main reason for acceleration of residual ridge relationship and night time wearing
resorption, so the aim of this review is to find a (11).Osteoporosis i s another common reason for
correlation between diabetes mellitus and residual ridge RRR it usually increases with advance in age.
resorption. PATHOGENESIS of RRR

Keywords:- Diabetes Mellitus Type 1, Diabetes Mellitus Immediately foll owing the extract ion
Type 2, Residual Ridge Resorption.

I. INTRODUCTION High well rounded ridge with sharp edges

Diabetic mellitus is a chronic metabolic

disorder in the body, diagnosed by increased blood As the resorption continues, ridge
glucose level in the blood .Diabetes mellitus is eventuallybecomes knife edged
classifi ed into(a) type 1( insulin dependent) an d(b)
t ype 2(noninsulin - dependent)(1). In type 1, the
destruction of beta cells in pancreas lea ds to lack as the process continues, remodelling of the bone
of insulin availability in the body , in type takes place eventually making the the ridge low
2diabetes mellitus either there is lack of and well-rounded with smooth edges
production of insulin or body cannot use the
produced insulin. (2,3).Type 1 diabetes is a chronic
disease which is due to small amount of insulin Eventually, this too resorbs, leavin g a depressed
production by the organ called pancreas, insulin is ridge(18).
a hormone which is needed for sugar to enter into
the cells to produce energy. T ype 1 diabetes II. BONE RESORPTION AT CELLULAR LEVEL
usually occurs in early stage of life. T ype 2 is (BMD)
usually due to genes, excessi ve weight gain and
unhealthy li fest yle,and it’s the most common t ype Osteoclasts breakdown the tissues in the bone
compared to type 1. (4,5)Diabetic mellitus affects which leads to increased calcium level in the blood
more than 100 million people worldwide. India which is called as bone resorption. The hallmark of
leads the world with the largest number of diabetic the resorbing surface is the appearance of
mellitus and has been declared has “diabetic scalloped erosi on, called Howships’s or resorption
capital of the world”by WHO(6). Residual ridge lacuna.(12)Currently, bone resorption density
resorption (RRR)is a natural process which occurs (BMD) is most reliable diagnostic standard given
after loss of teeth , in which the bone undergoes by WHO. T-score, is representation of BMD
constant remodelling(7).RRR is nothing but quality valuethat is the number of standard deviations that
and quantity changes of the bone aft er teeth has shows whether the individualis above or bel ow the
been extracted(8).RRR is greater during the first average of healthy adult.
few months of extraction and eventually the
resorption process sl ows down .The rate of
resorption is more in lower jaw (mandible)than

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 Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
III. RESIDUAL RIDGE RESORPTION IN DIABETIC PATIENTS VS NON DIABETIC PATIENTS

According to the study done by oxford dental collegeand hospital, showedthat, when compared among male and female
groups the females had significantly increased resorption compared to the male group.

Parameters Gender n mean std.Deviation P-

value
Rtmand.premolar male 24 11.10 2.29 0.022*
Female 26 13.24 3.85
Ltmand .premolar Male 24 11.36 2.56 0.049*
female 26 13.35 4.37
Rt.max.premolar male 24 12.62 2.69 0.012*
female 26 14.66 2.78
l.ma.premolar male 24 12.27 2.51 .008*
female 26 14.46 3.00
R.max.molar male 24 11.52 2.72 .013*
female 26 13.87 3.58
L.max.molar male 24 11.19 2.30 .012*
female 26 13.67 4.17
*p<0.05-significant-Indicates significant at 5 % level of significance(13).

Residual ridge resorption was significantly increased VI. DISCUSSION

among diabetics than non- diabetics and diabetics had
significantly more RRR in mandibular premolar region and Prosthodontics rehabilitation becomes a difficult task
maxillary premolar and molar region. A weakpositive co- when there is extensive residual ridge resorption which leads
relation was observed between the time period of to failure of complete dentures. Some of the etiological
edentulousness and alveolar bone resorption in both the causes related with RRRare quality ,quantity and shape of
gender (13.)Another study done by Osama Al-Jabrah, the residual ridge,muscle attachment, patients age, gender
reveals that the diabetic patient had twice the amount of ,Ca deficiency, osteoporosis and disturbances in hormone
RRR compared to controls. Significantly diabetic females production. These factors together cause changes in the
had greater RRR than diabetic males. The amount of RRR edentulous maxilla and mandible which leads to
was of greater in patients who had been edentulous for more RRR(14).DM is a carbohydrate metabolism disorder which
number of years had greater residual ridge resorption is caused by either insulin insufficiency or unable to use the
compared to the patients who became recently edentulous. available insulin(insulin resistance). The studies suggested
that the patients with uncontrolled or poorly controlled
IV. RESIDUAL RIDGE RESORPTION AND POST- T2DM had morechance of residual ridge resorption and
MENOPAUSAL WOMEN more severe bone loss when compared to individuals who
didn’t have diabetic(19).The patients with T2DM were
According to the study done by Dr. Prithika positively associated with increased chances for a change in
Eswaramurthy form Goa dental college. The mandibular bone score compared to subjects without diabetes (20).These
residual ridge resorption had 0.5% increased resorption results suggest that poorly controlled diabetes patients
compared to the controlgroup. That is completely suffered from both an increased risk for teeth loss which was
edentulous, post-menopausal diabetic women had more followed by alveolar bone loss and more severe progression
ridge resorption compared to non- diabetic post-menopausal over those without T2DM(21). Most common cause for
women(15). teeth loss in poorly controlled diabetes was periodontal
problems. There are lot of techniques to determine RRR but
V. BONE DENSITY AN ANTI- DIABETIC DRUGS orthopantomography (OPG) is most commonly used in
studies ,due to benefits such as the image of both maxilla
The study was done by Mohsen soroush reveals that and mandible in a single film, with relatively low radiation
T2DM its self is not the main reason for bone resorption but dose, takes short time for processing and economically
the medications that is anti-diabetic drugs are the main efficient compared to other techniques (22). This technique
reason for severe bone resorption (16).Another review also helps to localize anatomical landmarks and provides
article by A.G.D. VIANNA concludes that patients with vertical bone dimensions. But the drawbacks are that image
type2DM had an increased risk of bone fractures, which distortion and mistake in image may occur and it only
was not predictable by BMD measurements. This risk is not provides 2 dimensional image does not provide 3
caused by a single factor but it is multi factorial and also due dimensional image (buccolingual view)ofthe bone (23).
to anti diabetic therapies(17). OPG’s are used for determining the bone density, as a
relationship between mandibular bone mineral density and
skeletal areas in evaluating osteoporosis has been shown
(24).

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
VII. CONCLUSION [12]. Mohamed A EL Maroush, Sarra A Benhamida, Ahmed
A Elgendy , Mohamed H ElsaltaniRRR, the effect on
The aim of this review was to find the prosthodontics management of edentulous patient: An
correlation bet ween diabetic mellitus and residual article review Doi:10.18535/ijsrm/v7i9.mp04
ridge resorption ,concludes that diabetic patient [13]. Dr.Jayarekhatadiparthi and Dr.Sujatha, D. Evaluation
had more residual ridge resorption compared to of vertical bone heights of maxillary and mandibular
non-diabetic patients. This reinforces the necessit y residual ridges among edentulous diabetics by digital
of dental practitioners to have knowledge about orthopantomograph,International Journal of current
systemic conditions like diabetic mellitus and its research vol.8,(2016) 40608-40612.
correlation with clinical findings, given that these [14]. Osama Al-Jabrah association of type 2 diabetes
may influence individuals dental treatment mellitus with the reduction of residual ridge among
planning. edentulous patients using panoramic radiographs,open
journal of stomatology,2011,1,61-68.
REFERENCES [15]. Dr.PrithikaEswaramurthy, Dr.Meena, comparative
study of mandibular RRR between non -diabetic and
[1]. Banchi, c., Miccoli, R., Penno G and Del pratos . 2008. diabetic edentuluous post-menopausal women,
Primary prevention of cardiovascular disease in people International Journal of Current research vol.11,7328-
with dysglycemia dental care., 31, 208-214. 7332.
[2]. Nouwen, A, Winkley, K, Twisk, J, Lloyd, C, Peyrot, [16]. MohenSoroush,MohsenAbbaszadeh and
M, Ismail, K, et al. Type 2 diabetes mellitus as arisk Soosansoroosh,The study of bone density in type 2
factor for the onset of depression : a systematic review diabetic patients and comparison with non-
and meta-analysis. Diabetologia; 53: 2480-2486 diabetic.,bio medical and pharmacology journalvol 7 ,
(2010) 585-589.
[3]. Group, U P D S. Tight blood pressure control and risk [17]. A.G.D.Vianna, C.P.Sanches and F.C.Barreto, review
of macrovascular and microvascular complications in article; effects of type 2 diabetes therapies on bone
type 2 diabetes: UKPDS 38. BMJ: British Medical metabolism., bio med central.
Journal ; 317 : 703 (1998) [18]. Dr.Abirami G, Samyukta , residual ridge resorption in
[4]. Trial, C. intensive diabetes treatment and comlete denture wearers , journal of pharmaceutical
cardiovascular disease in patients with type 1 diabetes. sciences and research vol 8(6) , 2016, 565-568
The NEW England journal of medicine; 353 : 2643 [19]. Taylor,G.W., Burt, B.A., Becker , M.P., Genco R.J and
(2005) shlossman ,M (1998) Glycaemia control and alveolar
[5]. Karvonen, M, Tuomilehto, J, libman, I and Laporte, R. bone loss progression in type 2 diabetes. Annals of
A review of the recent epidemiological data on the periodontology, 3, 3039-3034.
worldwide incidence of type 1 (insulin-dependent) [20]. Watanabe,P.C.A ., Farman, A., Watanabe, M.G.D.C.
diabetes mellitus.Diabetologia; 53: 2480-2486 (1993) and Issa, J.P.M. (2008) Radiographic signals detection
[6]. Dr.Ajaysingh, senior lecture HKES S. Nijalingappa of systemic disease. Orthopantomographic
Institute of dental science and research. Correlation radiography. International Journal of
between edentulism, nutrition and diabetes. Morphology,26,915-926.
[7]. Atwood, D.A Essentials of complete denture [21]. Zlataric, D.K., Celebic, A. and
prosthodontics 1988, 2nd edition, PSG pubco, Littleton Lazic,B.(2002)Resorption changes of maxillary and
22- 38 mandibular bone structures in removable denture
[8]. Atwood DA 1962, some clinical factors related to rate wearers. ActaStomatologica Croatica,36, 261-265.
of resorption of residual ridges J. prosthet.Dent., [22]. wilding, R.J.C, Levin I and Pepper,R(1987) The use of
26:266-279. panoramic radiographs to measure alveolar bone areas.
[9]. Kovaci , I., Celebic A., Zlataric , D.K., Stipetic ,J. and Journal of oral rehabilitation,14,557-567.
Papic,M.(2003) Influence of body mass index and time [23]. Rockenbach, M.I.B., Sampaio, M.C.C., da Costa,L.J.
of edentulusness on the residual alveolar ridge and da Costa, N.P.(2003) Evaluation of mandibular
resorption in complete denture wearers collegium implant sites: correlation between panoramic and
antropologium, 27, 69-74. linear tomography. Brazilian Dental Journal,14,209-
[10]. Habets,L.L., Bars,J and Borgmeyer-Hoelen 213.
,A.M.(1988) mandibular atropy and metabolic bone [24]. Durta, V., Yang, J., Devlin, H. and Susin,
loss. International journal of oral and maxillofacial C.(2005)radiomorphometric indices and their relation
surgery. to gender ,age, pathology, oral radiology and
[11]. Tallgren,A (1970) Alveolar loss in denture wearers as endodontology,99,479-484.
related to facial morphology.

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