Impact of Smoking as a Risk Factor for Dental Implant Failure: A Critical Review

Abstract

Abstract Introduction There are numerous studies in the published literature that report on the increased risk of implant complications and failure in patients who smoke. An association between dental implants, grafting procedures (e.g. bone grafts maxillary sinus augmentation) and smoking history has been reported in the literature. Cigarette smoking may adversely affect wound healing and thus, jeopardize the success of bone grafting and dental implantation. Aim The aim of the present study was to conduct a critical review to evaluate the effects of a dose dependent impact of smoking on the success or failure of dental implants. Method A systematic search of the electronic databases and subsequent hand searching of the relevant articles published in English was performed and resulted in 60 papers. Of the 60 papers identified by this process, only eight studies were included in the review, based on the inclusion and exclusion criteria. Results The included studies compared the effects of smoking on both marginal bone loss and implant failure. Four out of five studies reported a strong correlation between smoking and an increased risk of implant failure. However, only two of the four studies reported on whether the risk of implant failure was affected by the quantity of daily cigarette consumption. Furthermore, of the three studies that analysed the effect of smoking on marginal bone loss, only two studies reported an increase in bone loss in smokers. None of the included studies demonstrated any correlation between smoking dose and increased marginal bone loss around a dental implant. The results suggested that there are limited evidenced-based data regarding the establishment a relationship between the quantity of cigarette consumption (in terms of smoking dose) and its effect on dental implant failure. There appeared to be limited data on clinical dental implant protocols regarding the acceptance of smokers in terms of a dose-related risk when considering patient suitability for implant placement. Conclusions The results from these studies included in the present review would therefore emphasize the importance of a patient’s smoking status and the necessity of assessment and their ability to comply with professional recommendations, including oral hygiene instructions, prior to any implant treatment planning procedure. The patient should also be advised of the possibility of a poor prognosis following implant placement in patients who smoke, particularly in the maxillary region and in advanced surgical techniques e.g., sinus lift or bone regeneration.