How does diabetes contribute to peri-implantitis? All of the following EXCEPT:

Correct answer: D. Inhibits osteoclastic activity

• A. Impaired neutrophil chemotaxis and phagocytosis is a well-established diabetic defect that raises peri-implant infection risk.
• B. Hyperglycemia and advanced glycation end products (AGEs) suppress osteoblast differentiation and reduce bone formation — this DOES occur.
• C. Diabetes impairs collagen synthesis and increases collagenase activity, compromising soft tissue healing around the implant — this DOES occur.
• D. Correct (the EXCEPTION). Diabetes INCREASES osteoclastic activity and bone resorption — largely through the RAGE/AGE pathway and elevated RANKL. Saying it inhibits osteoclasts reverses the actual mechanism, which is precisely why marginal bone loss around implants accelerates in poorly controlled diabetics.