In this answer
What your A1C number means
A1C is a three-month measure of your blood-sugar control, usually followed by an endocrinologist. Above 6.5 is generally the line for diabetes.
As a rough guide, six to seven and steady means your diabetes is well controlled. Eight and above is worth working on with your doctor before surgery.
Blood sugar and the bone around an implant
Bone lost around the implant in 2 years
A review of 14 studies found that implants failed about as often in people with diabetes as in people without it. Where blood sugar does show up is in the bone around the implant. In this two-year study, people with an A1C of 8.1 to 10 lost more than twice as much bone. That is why we want your A1C under control before surgery.
85 people with type 2 diabetes, put in groups by their A1C. Each had one implant in the front of the upper jaw. These were single-tooth implants, not full arch. The study summary gives no number for the middle group (A1C 6.1 to 8).
- Aguilar-Salvatierra A, et al. Peri-implant evaluation of immediately loaded implants placed in esthetic zone in patients with diabetes mellitus type 2: a two-year study. Clin Oral Implants Res. 2016;27(2):156-61. PMID 25623884.
- Across 14 studies, diabetes did not significantly change implant failure rates: Chrcanovic BR, et al. Diabetes and oral implant failure: a systematic review. J Dent Res. 2014;93(9):859-67. PMID 24928096.
Why blood sugar matters for an implant
Diabetes affects your smallest blood vessels and how new ones form. Blood flow is what knits an implant into the bone.
When blood sugar is high, less blood reaches the implant site. That can get in the way of the implant bonding with the bone, and it can lead to bone loss.
At your consultation
An A1C of nine doesn't mean no. It usually means a talk with your doctor, an adjustment to your medicine, some lifestyle changes, and then surgery from a stronger starting point.
Even after the procedure, they went above and beyond by calling to follow up the next day and multiple times afterward to ensure I was healing properly and feeling great.
One thing we do differently
Most full-arch patients get a short-acting steroid to keep swelling down. For diabetic patients we usually skip it, because steroids raise blood sugar and work against the control you've spent weeks building.
We use ibuprofen and acetaminophen instead, and that usually does the job.
Quick answers
What A1C do I need before implant surgery?
Six to seven and steady means well-controlled diabetes. At eight or above, it's worth working on with your doctor before we schedule.
Will I still get something for swelling?
Yes. For diabetic patients we usually manage swelling with ibuprofen and acetaminophen rather than a steroid.
Does diabetes affect the 90-day soft diet?
No. The soft-diet period is the same for everyone. What changes is how closely we watch your healing. With diabetes, especially if your control has gone up and down, an implant takes longer to settle into the bone and the gum around it gets inflamed more easily. So your checkups are closer together and we look more closely at the gum around each implant. Your part is keeping your blood sugar where your doctor wants it through the healing months.
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What is periodontal disease, and why does it lead to full-arch implants?
Periodontal disease is an imbalance in the mouth's bacteria that goes on for years. Slowly it breaks down the bone, inflames the gums, and loosens teeth until they're lost. It's the most common road to full-arch treatment. Most people who need a full arch got here after years of gum disease that was never treated or never stayed under control.
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Read the full answerCan I get dental implants if I smoke?
Yes. Nobody here will turn you away because you smoke. Smoking does raise the risk to how your implants heal, and how much you smoke matters. The research draws the line at about half a pack a day. If you can cut down before surgery and stay off it for six to eight weeks afterward, you give yourself noticeably better odds.
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Read the full answerWhat is peri-implantitis, and how is it different from gum disease?
Peri-implantitis is inflammation and bone loss around an implant. It's the implant version of gum disease, and it can move faster. A natural tooth is held in by a ligament and a root layer called cementum. An implant has neither, so the gum holds on less firmly and trouble can build more quickly. That's why your yearly check matters even more once you have implants.
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