Orthodontic treatment of a patient with Type 1 diabetes mellitus.

ic disorder characterized by either partial or total deficiency of insulin or by a resistance to that hormone, leading to an increase in blood glucose levels and subsequent complications.1 Most cases of diabetes mellitus fall into two categories: type 1 (insulin-dependent) and type 2 (some combination of insulindeficient and insulin-resistant).2 Type 1 diabetes mellitus is distinguished by a complete lack of insulin production, usually accompanied by intense hyperglycemia and ketoacidosis. Most patients develop the disease during childhood and require exogenous insulin injections to survive.1 The five classic complications of diabetes are microangiopathy, neuropathy, nephropathy, macrovascular diseases, and wound-healing delay.3-5 The World Health Organization added periodontal disease as a sixth classic complication in 1993. The increased risk of periodontitis in diabetic patients is associated with multiple factors, including the patient’s age, the duration of the diabetes,2,6,7,16-18 the presence or absence of metabolic controls, and the level of bacterial plaque.2,8,9 Adults with type 1 diabetes have been found to be more susceptible than nondiabetic adults to gingivitis and periodontitis.11,12 Over a long period of time, type 1 diabetes can alter the periodontal tissue and thus speed up the clinical loss of periodontal ligament insertion.10 Bone metabolism is adversely affected by both the direct impact of hyperglycemia and the long-term effects of vascular disease.13-15 Furthermore, patients whose diabetes is inadequately controlled tend to show a greater loss of insertion and alveolar bone than patients with wellcontrolled diabetes.7,19-21 These findings are significant for the orthodontist, because if a diabetic patient presents with advanced periodontal disease, it will be necessary to use the least traumatic treatment possible to avoid a worsening of the already deficient periodontium. The present article reports an orthodontic treatment involving the extraction of four second premolars in an adult patient with type 1 diabetes mellitus and a widespread loss of supporting bone.