Vitamin D3 and insulin combined treatment promotes titanium implant osseointegration in diabetes mellitus rats

This study investigated the effect of insulin and vitamin D₃ (VD₃) treatment on implant osseointegration in diabetic mellitus (DM) rats. DM was induced by administration of streptozotocin in rats, which received implants insertion in the femur. Then animals were subjected to different treatment and divided to the following group: control, diabetic, insulin-treated diabetic, VD₃-treated diabetic, insulin and VD₃ combination-treated diabetic rats. The glucose levels and weight of rats were periodically evaluated, and serum 25(OH)D₃ levels in rats were measured at the end of the experiment. Animals were sacrificed at 12 weeks after surgery, the peri-implant trabecular microstructure, implant fixation and implant osseointegration were measured by microscopic computerized tomography (micro-CT) evaluation, push-out test and histomorphometric analysis. Diabetic rats displayed significantly higher blood glucose level, lower body weight, lower serum 25(OH)D₃ levels, and less implant osseointegration than controls. Insulin treatment showed restorative effect on body weight and serum 25(OH)D₃ levels of diabetic rats, but the blood glucose level in diabetic rats were still substantially higher compared to controls after 14 days therapy of insulin. Combined treatment restored hyperglycemia in diabetic rats to be normal, and reversed the impaired osseointegration capacity of implants, with the bone volume ratio and percent osseointegration increased by 1.37-fold and 1.6-fold in micro-CT evaluation, the maximal push-out force and ultimate shear strength by 1.3-fold and 2.1-fold in push-out test, and the bone-to-implant contact and bone area ratio increased by 2.57-fold and 1.44-fold in histomorphometric analysis. Monotreatment also enhanced implant fixation, but less. These results indicated that insulin and VD₃ combined treatment may be an effective approach to enhance implant fixation in diabetic rats, but whether the results could be extrapolated to human needs further study.