Smoking and Dental Implants

Smoking adversely affects dental implant treatment. Pi Dental Center treats patients who smoke by helping them to quit smoking prior to implant treatment.

Cigarette smoking has long been known to be associated with a variety of oral conditions including periodontal disease, bone loss, tissue loss, tooth loss, edentulism, peri-implantitis and dental implant failure.

Nicotine in tobacco has been shown to reduce the blood flow in the mouth. Pipe smoking can be worse than cigarettes due to the higher temperatures generated in the upper jaw. Not only is smoking detrimental to implants, it is also bad for conventional bridgework.

Periodontal Disease
Twenty years of research shows that cigarette smoking is probably a true risk factor for periodontitis. A smoker is 2 to 3 times as likely to develop clinically detectable periodontitis. In addition to increased prevalence, smokers also experience more severe periodontal disease.

Bone and Tissue Loss
A study examining the effect of oral-burn syndrome on dental implants indicated that there is a direct link between oral tissue loss and smoking.1 In addition, smoking had a significant impact on bone loss.7

Tooth Loss and Edentulism
Tooth loss and edentulism is more common in smokers than in non-smokers.4 Tooth loss in older adults occurs because of increased exposure to pathogenic bacteria.2,6 Smoking also predisposes patients to develop more severe periodontal disease.2,6

The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a retrospective study conducted at the University of Vienna, the peri-implant tissue of smokers and non-smokers was compared. The smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.8

Dental Implant Failure
Many research studies have shown that smoking can lead to higher rates of dental implant failure. 3,4,5,6 Senerby and Roos discussed determinants for success in osseointegrated oral implants, confirming that smoking may lead to higher implant failure rate.3

Smoke Cessation
Previous smokers have a lower risk for periodontitis than current smokers. Smoking cessation will result in improved periodontal health and improve a patients chance for successful implant osseointegration.4,9

Whichever course of treatment patients decide to pursue, they can expect slower healing and a greater possibility of failure if they continue to smoke during or following treatment healing period. If patients stop smoking three to four weeks prior to implant placement and remain smoke free during the healing period, results MAY improve. Some dentists do place dental implants in smokers, but these patients must be aware of the increased risk they assume.

Many of our smoking patients have used implant treatment as an opportunity to quit smoking altogether. The dentists in our office prescribe smoke cessation medications and products to assist in the quitting process.

1. The oral-burn syndrome and its effects on dental implants. R. Cullen. J Oral Implantol 1998;24(4):219-21.

2. Periodontal diseases and dental implants in older adults. Wilson, Higginbottom. J Esthet Dent 1998;10(5):265:71.

3. Surgical determinants of clinical success of osseointegrated oral implants: a review of the literature. Sennerby, Roos. Int J. Proshtodont 1998 Sept-Oct; 11(5):408-20.

4. Cigarette smoking and periodontal diseases: etiology and management of disease. Tonetti. Ann Periodontol 1998 Jul;3(1):88-101.

5. Biological factors contributing to failures of osseointegrated oral implants. (II) Etiopathogenesis. Esposito, Hirsch, Lekholm, Thomsen. Eur J Oral Sci 1998 Jun;106(3):721-64.

6. Influences of smoking on the periodontium and dental implants. Dent Update 1997 Oct; 24(8)328-30.

7. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss [published erratum appears in Clin Oral Implants Res 1997 Aug;3(4):342] Clin Oral Implants Res 1996 Dec;7(4):329-36.

8. The relationship of smoking on peri-implant tissue: a retrospective study. Haas R; Haimbock W; Mailath G; Watzek G. J Prosthet Dent 1996 Dec;76(6):592-6.

9. Smoking and implant failure—benefits of a smoking cessation protocol. Int J Oral Maxillofac Implants 1996 Nov-Dec;11(6):756-9.

10. The effect of smoking on early implant failure. DeBruyn, Collaert. Clin Oral Implants Res 1994 Dec;5(4):260-4.


  • The effect of smoking on osseointegrated dental implants. Part II: Peri-implant bone loss. Int J Prosthodont. 2006 Nov-Dec;19(6):560-6. DeLuca S, Habsha E, Zarb GA, Implicates smoking as a significant factor in the failure of dental implants. Smokers had a significantly higher implant failure rate (23.08%).

  • Smoking and complications of endosseous dental implants. J Periodontol. 2002 Feb;73(2):153-7. Schwartz-Arad D, Samet N, Samet N, Mamlider A. Dental implant complications and survival rates were compared among smokers and non-smokers. In addition to a higher failure rate, smokers demonstrated a significantly higher complication rate than non-smokers.

  • The effect of cigarette smoking on dental implants and related surgery. Implant Dent. 2005. Dec;14(4):357-61. Levin L, Schwartz-Arad D. Increased plaque accumulation, higher incidence of gingivitis and periodontitis, higher rate of tooth loss, and increased bone resorption of the alveolar ridge in the oral cavity have been observed in smokers. Heat as well as toxic by-products of cigarette smoking, such as nicotine, carbon monoxide, and hydrogen cianide have been implicated as risk factors in impaired healing and adversely affect success and complications of surgical procedures.

  • Influence of smoking on osseointegrated implant failure: a meta-analysis. Clin Oral Implants Res. 2006 Aug;17(4):473-8. Hinode D, Tanabe S, Yokoyama M, Fujisawa K, Yamauchi E, Miyamoto Y. This analysis revealed a significant relationship between smoking and the risk of osseointegrated dental implant failure, more particularly those implants placed in the maxillary arch.

Link to the CDC General Information about the Effects of Smoking

CDC Tips – Tobacco Information and Prevention Source:

Tobacco and your oral health

Link to Tobacco Free Life Website

Pi Dental Center, Fort Washington, PA