Effects of Prediabetes on Bone Metabolism and Healing in Orthognathic Surgery: A Narrative Review

Prediabetes, defined by impaired glucose regulation, is an increasingly prevalent metabolic disorder with implications beyond glycemic control. Its impact on bone remodeling and healing is gaining attention, particularly in orthognathic surgery. This narrative review aimed to map the current evidence regarding the impact of prediabetes on bone healing, metabolic markers, and surgical outcomes in orthognathic surgery. A comprehensive literature search was performed (PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) up to January 2025, yielding 32 eligible studies. Emerging data suggest that prediabetes may influence bone homeostasis through insulin resistance, low-grade chronic inflammation, and the accumulation of advanced glycation end products. These changes may attenuate the systemic acceleratory phenomenon observed after surgical trauma, potentially delaying bone healing. However, current evidence is limited by significant assay heterogeneity, varying temporal sampling windows, and a lack of prospective surgical trials. While not as severe as overt diabetes, prediabetes constitutes an underrecognized but important risk factor in the perioperative management of orthognathic surgery patients. Future research should prioritize standardized prospective trials to establish evidence-based guidelines.