Effect of smoking over one pack daily on implant healing and health: A cohort study

Abstract

Background: This prospective cohort trial examines the effects of heavy smoking on peri-implant marginal bone loss (MBL) and implant survival rates over 15 months.

Methods: Thirty subjects, categorized as either smokers (more than 20 cigarettes daily for over 5 years) or non-smokers, were initially recruited with pocket depths ≤ 5 mm and at least one missing tooth. Urine cotinine assay was used to confirm smoking status. Implants were placed and restored after 4 months. Clinical, radiographic and stability variables were assessed at placement, 15, 24, and 67 weeks. Measurements included marginal bone height, peri-implant pocket depth, implant stability, bleeding on probing, and plaque index. Statistical analyses included Mann-Whitney tests for continuous variables, Fisher exact tests for categorical variables, and generalized estimating equations for longitudinal changes.

Results: Thirteen implants were installed in the smoker group (11 subjects) and 18 in the non-smoker group (18 subjects). Survival rates were lower in smokers (84.6%) compared with non-smokers (94.4%). Smokers experienced significantly greater marginal bone loss 12 months after final reconstruction (1.5 ± 0.3 mm versus 0.7 ± 0.6 mm; p = 0.008). Pocket depth was slightly greater in smokers but this did not reach statistical significance.

Conclusions: Heavy smoking significantly increases marginal bone loss and decreases implant survival. Further research is needed to corroborate these findings and develop intervention programs.

Plain language summary: Heavy smoking is a well-known risk factor for poor dental health, yet its effects on dental implants are less frequently examined. This study investigated how heavy smoking (more than 20 cigarettes daily for at least 5 years) impacts the success of dental implants. We monitored 29 patients, including both heavy smokers and non-smokers, over 15 months after implant placement and restoration. We evaluated bone loss, implant stability, and success rates. Our results showed that heavy smokers experienced significantly more bone loss-twice as much as non-smokers-along with slightly reduced implant stability and survival. These adverse outcomes likely relate to smoking's negative effects on bone healing and immune function. Our findings underscore the importance of addressing smoking before implant procedures and suggest that quitting smoking could greatly improve long-term outcomes. Further research is needed to develop strategies for mitigating the risks of smoking in implant dentistry.

Keywords: bone loss; bone remodeling; dental implants; implant survival rate; marginal bone loss; peri‐implantitis; smoking.