Research update – implant dentistry and nicotine use

implant dentistry nicotine

Implant Dentistry Today examines the latest evidence looking into the impact of smoking and e-cigarettes on implant treatment.

Naseri R, Yaghini J, Feizi A (2020)

Levels of smoking and dental implants failure: A systematic review and meta-analysis

J Clin Periodontol 47(4): 518-528


The present systematic review and meta-analysis was performed to investigate if there was a significantly enhanced risk of dental implant failure due to the increased number of cigarettes smoked per day.

Material and methods

Four databases, including PubMed, Embase, Web of Science and Scopus, were searched until January, 2019. The search terms ‘dental implant, oral implant, smoking, smoker, tobacco, nicotine and non-smoker’ were used in combination to identify the publications providing data for dental implant failures related to the smoking habit.

Publications were excluded if the quantity of cigarettes consumed per day was not reported. Fixed- or random-effects meta-analyses were used to pool the estimates of relative risk (RR) with 95% confidence intervals (CI).


Having additional information supplied by the authors, 23 articles were selected for final analysis. The meta-analyses based on implant- and patient-related data showed a significant increase in the RR of implant failure in patients who smoked >20 cigarettes per day compared with non-smokers (implant based: p = .001; RR: 2.45; CI: 1.42-4.22 and patient based: p < .001; RR: 4; CI: 2.72-5.89).


The risk of implant failure was elevated with an increase in the number of cigarettes smoked per day.

Windael S, Vervaeke S, De Buyser S, De Bruyn H, Collaert B (2020)

The long-term effect of smoking on 10 years’ survival and success of dental implants: a prospective analysis of 453 implants in a non-university setting

J Clin Med 9(4): 1056


The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers.

Material and methods

All patients referred for implant treatment between November 2004 and 2007 were scrutinised. All implants were placed by the same surgeon (BC). The single inclusion criterion was a follow-up time of at least 10 years. Implant survival, health, and bone loss were evaluated by an external calibrated examiner (SW) during recall visits. Radiographs taken at recall visits were compared with the post-surgical ones.

Implant success was based on two arbitrarily chosen success criteria for bone loss (≤1 mm and ≤2 mm bone loss after 10 years). Implant survival in smokers and non-smokers was compared using the log-rank test. Both non-parametric tests and fixed model analysis were used to assess bone loss in both groups.


A total of 453 implants in 121 patients were included for survival analysis, and 397 implants in 121 patients were included for peri-implant bone-loss analysis. After a mean follow-up time of 11.38 years (SD 0.78; range 10.00-13.65), 33 implants out of 453 initially placed had failed in 21 patients, giving an overall survival rate of 92.7% and 82.6% on the implant and patient level, respectively.

Cumulative 10 years’ survival rate was 81% on the patient level and 91% on the implant level. The hazard of implant loss in the maxilla was 5.64 times higher in smokers compared to non-smokers (p = 0.003). The hazard of implant loss for implants of non-smokers was 2.92 times higher in the mandible compared to the maxilla (p = 0.01). The overall mean bone loss was 0.97 mm (SD 1.79, range 0-17) at the implant level and 0.90 mm (SD 1.39, range 0-7.85) at the patient level.

Smokers lost significantly more bone compared to non-smokers in the maxilla (p = 0.024) but not in the mandible. Only the maxilla showed a significant difference in the probability of implant success between smokers and non-smokers (≤1 mm criterion p = 0.003, ≤2 mm criterion p = 0.007). Taking jaw into account, implants in smokers experienced a 2.6 higher risk of developing peri-implantitis compared to non-smokers (p = 0.053).


Dental implants with a fluoride-modified surface provided a high 10 years’ survival with limited bone loss. Smokers were, however, more prone to peri-implant bone loss and experienced a higher rate of implant failure, especially in the upper jaw.

The overall bone loss over time was significantly higher in smoking patients, which might be suggestive for a higher peri-implantitis risk. Hence, smoking cessation should be advised and maintained after implant placement from the perspective of peri-implant disease prevention.

Badenes-Catalán J, Pallarés-Sabater A (2021)

Influence of Smoking on Dental Implant Osseointegration: A Radiofrequency Analysis of 194 Implants

J Oral Implantol 47(2): 110-117 

Many studies have related smoking to peri-implantitis and marginal bone loss. However, little is known of its potential impact on dental implant osseointegration. The present clinical study explores the influence of smoking on secondary stabilisation based in radiofrequency analysis.

A total of 194 implants in 114 patients were included. Implant stability was evaluated on the day of surgery and at a minimum of 90 days after implantation, when osseointegration is considered to have been completed. The evolution of implant stability was compared between two groups: smokers and nonsmokers.

The following variables were also analysed: implant brand and model, length, diameter, insertion torque, bone density according to the Misch classification, location of the implant, and patient age and gender. The results showed that smoking did not affect the primary stability of the implant. Although, it was associated with a marked decrease in secondary stability.

The nonsmokers showed a gain of 2.69 points (95% confidence interval [CI]: 1.529-3.865; P < .001) in the osseointegration process. However, in the smokers group, implant stability was seen to decrease 0.91 points (95% CI: -3.424 to 1.600; P < .004), generating a difference of 3.61 points between smokers and nonsmokers. Smoking is thus concluded to be an important factor. It must be taken into account when seeking good implant osseointegration outcomes.    

This article first appeared in Implant Dentistry Today magazine.. You can read the latest issue here.

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