Prevalence of Bone Loss in Mandibular Future Abutment Teeth among Diabetic and Non-Diabetic Patients: A Retrospective Case-Control Study

Marwa Madi1, *, Eman Bakhurji1, Ali Alghwainem2, Ali Alamer2, Salma Alarfaj2, Soha AlRatroot2, Verica Pavlic3, 4
1 Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 314111982, Kingdom of Saudi Arabia
2 College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 314111982, Kingdom of Saudi Arabia
3 Department of Periodontology and Oral Medicine, Institute of Dentistry, Banja Luka 78000, Bosnia and Herzegovina
4 Department of Periodontology and Oral Medicine, Medical faculty University of Banja Luka, Banja Luka 78000, Bosnia and Herzegovina

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© 2022 Madi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31411/P.O. Box1982, Kingdom of Saudi Arabia; E-mail:



This study aimed to compare the prevalence of bone loss in lower permanent premolars and canines, which can serve as abutments for future prostheses, among diabetic and non-diabetic patients.

Materials and Methods:

In this retrospective case-control study, records of patients who visited the dental clinics of Imam Abdulrahman Bin Faisal University were used. Inclusion criteria were the presence of a complete periodontal chart, full mouth radiographs, and past medical history (presence of DM, hypertension, and/or coronary heart disease). The criteria for exclusion were the reporting of malignancy, pregnancy, breastfeeding, or taking of the medications that affect bone turnover, periodontal surgery within the past year, absence of radiographs with good quality, and antibiotic use within 3 months prior to the dental visit. Demographical data, including gender and age, past medical history (diabetic state), and periodontal diagnosis, were collected. The severity of periodontal disease, radiographic bone loss (RBL), and its pattern were also assessed.


Out of 400 records, 363 patient files were included. Of those, almost 36% were males and 64% were females. The patients’ age was ranging from 16 to 82 years. About 34% of the patients were diagnosed with generalized periodontitis while 22% had localized periodontitis. With regards to the severity of the cases, the prevalence was equally distributed between mild (37%) and moderate periodontitis (38%), while 25% were diagnosed with severe periodontitis. A total of 22% of the patients were diabetic, which showed an increase in the severity of bone loss by an average of 31% across the selected teeth (mandibular canines and premolars). The pattern of bone loss was higher in the mandibular incisors, followed by the canines and the premolars. Multiple regression models showed that non-diabetics were significantly less likely to have bone loss in all the selected teeth and the male patients had 2 times the likelihood of having bone loss. Although the mandibular canines have the highest root length in the mandible, they were the most affected by bone loss in diabetic patients with periodontitis.


Results of this study suggested that mandibular premolars were the teeth least affected by bone loss in both, diabetic and non-diabetic groups. Therefore, they can be considered the most suitable teeth to be used as abutments for the future prosthesis.

Keywords: Bone loss, Diabetes mellitus, Abutment teeth, Periodontal disease, Mandibular premolars, Periodontitis.