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Association of Smoking With Early Implant Failure
TAKE-HOME MESSAGE
- Smoking has long been known to delay wound healing and is often associated with implant failure. This systematic review and meta-analysis evaluated the association between smoking and early dental implant failure using data from 32 observational studies involving 59,246 implants and 14,115 patients. The analysis revealed that smokers had a significantly higher risk of early dental implant failure than nonsmokers, with an odds ratio of 2.59 at the implant level and 2.00 at the individual level. Smoking was associated with a greater risk of early implant failure for maxillary implants than for mandibular implants. Although the study provides compelling evidence of the link between smoking and early implant failure, potential confounding factors such as the amount of tobacco used, patient comorbidities, and various surgical techniques were not extensively explored.
- Smoking significantly increases the risk of early implant failure, particularly in the maxilla. This finding underscores the importance of smoking cessation in improving implant success rates.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To assess the association between smoking and early dental implant failure by conducting a systematic review and meta-analysis of observational studies.
DATA SOURCES
PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched for reports of relevant studies addressing the relationship between smoking and early dental implant failure published between database inception and June 2024.
STUDY SELECTION
Thirty-two observational clinical studies published between 1994 and 2024 were included, with a total of 59,246 implants at implant level and 14,115 patients at individual level. At implant level, a meta-analysis of 21 included cohort studies showed that smoking was associated with increased risk of early dental implant failure compared with non-smoking (odds ratio [OR], 2.59; 95 % confidence interval [CI], 2.08-3.23). Three included studies reported that smoking was associated with higher maxillary early dental implant failure risk (OR, 5.90; 95 %CI, 2.38-14.66) than that of mandible (OR, 3.76; 95 %CI, 1.19-11.87). At individual level, meta-analysis of thirty cohort studies indicated that risk of early implant failure in smokers was 100 % higher than in non-smokers (OR, 2.00; 95 %CI, 1.43-2.80). Three case-control studies found that risk of early implant failure of smokers was 59 % higher than that of non-smokers (OR, 1.59; 95 %CI, 1.28-1.97).
CONCLUSIONS
Smoking was significantly associated with early dental implant failure, particularly at the maxillary location, at both implant and individual level. These findings suggest smoking cessation is a crucial factor in reducing risk of early dental implant failure.
CLINICAL SIGNIFICANCE
There is uncertainty about the extent to which smoking influences early dental implant failure, our meta-analysis of findings emphasize smoking was significantly associated with early dental implant failure, particularly at the maxillary location.
Additional Info
Disclosure statements are available on the authors' profiles:
Smoking in relation to early dental implant failure: A systematic review and meta-analysis
J Dent 2024 Oct 09;151(xx)105396, YY Fan, S Li, YJ Cai, T Wei, P YeFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This systematic review and meta-analysis evaluated the impact of cigarette smoking on early dental implant failure, defined as failure prior to abutment connection.
A total of 32 observational (case–control and cohort) clinical studies were included. These studies were published between 1994 and 2024, involving 59,246 implants placed in 14,115 patients. Overall, 27 studies were classified as high-quality and 5 were classified as moderate-quality based on the Newcastle–Ottawa scale. No publication bias was found. The main findings of the meta-analysis are as follows:
The authors examined the differences among former, current, and nonsmokers in a subset of manuscripts, but the information about the length of cessation before implant placement is unavailable. They reported that the odds of implant failure in smokers were not significantly different from those in ex-smokers (OR, 1.58; 95% CI, 0.80–3.12; P = .19). The odds of failure in nonsmokers were lower than those in ex-smokers (OR, 0.51; 95% CI, 0.29–0.88; P < .02).
This study underscores and strengthens the evidence that smoking has a negative impact on dental implant healing. These differences between smokers and nonsmokers are both statistically and clinically significant (OR, ≥2). The findings were consistent across different geographical regions, including Europe, Asia, and the US. Biologic factors responsible for this negative impact may be compromised vascularity, altered cell function, and a negative impact on cytokines/growth factors involved in the healing process. The most pronounced difference between smokers and nonsmokers was observed in the maxillary arch, where the odds of failure in smokers were almost 6 times those of nonsmokers. The authors hypothesized that the lower bone density in the maxillary arch may be a contributing factor.
A limitation is that the available literature lacks detailed information on the smoking dose and on what may be the most effective timeline for smoking cessation prior to implant placement. The measurement of nicotine’s metabolite, cotinine, would define the dose effect of smoking and help in clinical decision–making. Clearly, practitioners should recommend that their patients quit smoking, and having guidelines on cessation timing prior to implant surgery would be valuable.