Is smoking bad for dental implants?

#1: Smoking is the number-one risk factor for implant loss when it comes to what patients can control

Picture by Authority Dental under CC 2.0 license

Many aspects to do with implant success are at the responsibility of the specialist performing the procedure, the practice, and the quality of materials used. There are also patient-oriented considerations such as the general health status as well as the amount and quality of bone.

In terms of what the patient can control the most there are:

• adherence to post-op instructions,

• hygiene maintenance, and

• smoking habits.

Such an addiction has a huge impact on dental implant survival. Studies showed that smokers have a success rate of 84.2%, while for non-smokers it is 98.6%. Even when tobacco users have a better bone quality, the rate of failure is still higher than in non-smokers.

#2: The more cigarettes you smoke per day, the more likely that your implant will fail

Research shows that those who are heavy tobacco users (smoke over 20 cigarettes a day) are more likely to lose their implant. Many different studies confirm this hypothesis.

This leads to the conclusion that light smokers have a higher chance of keeping their implants than those who smoke heavily.

#3: Smoking during the implant process is especially dangerou

Ceasing from smoking for a week prior to your surgery allows the short-term effects of nicotine to reverse. This greatly increases the chances of implant survival in levels comparable to non-smokers.

In order to achieve the osteoblastic phase (when the bone cells reproduce most) of healing, you should also refrain from smoking for 2 months after your surgery. By taking care of your implant this way, you allow for osseointegration to begin without interference of nicotine and tobacco.

#4: Smoking can be responsible for bone loss and peri-implantitis which lead to implant failure

Picture by Authority Dental under CC 2.0 license

Smoking can induce bone loss, especially in the upper ridge it is less dense. When there is less bone, the placed implant (if it can be mounted at all) has a less sturdy base.

Additionally, smoking-induced peri-implantitis puts the implant at an even higher risk. This is because of inflammation and mucosal pockets which form around the implant. They make the ridge too weak to support a restoration in the long term.

This type of infection requires emergency dental care, can make your implant loose and may even need to be removed.

#5: Upper-teeth implants in smokers are more likely to fail than lower ones

Smokers were more likely to develop peri-implantitis in maxillary implants, leading to implant failure. This trend is not so visible in mandibular restorations.

Maxillary cavities are closer to the respiratory tract, which makes them more vulnerable to the damaging effects of tobacco. That may be why upper teeth implants fail more often than bottom ones.

#6: Implants placed in smokers who underwent sinus lifting fail twice as often as those of non-smokers

When the maxillary ridge is too thin or if the roots of upper teeth poke through into the hollow spaces in the skull called sinuses, augmentation is necessary.

Smokers have a harder time healing from this procedure. This is because the smoke irritates the special cells called cilia that are inside the sinus cavity.

#7: Smoking has a negative effect on an implant’s survival after the second-stage surgery

Tobacco use is significantly destructive just before insertion of prosthesis takes place. The most damage happens when the tissues immediately around the implant have contact with smoke.

When the implant site is reopened to attach the abutment, it also allows tobacco to come inside the gums, if the patient is a user. This weakens the structural integrity of the soft tissues, making the base for the implant less stable.

#8: Smoking increases arginase activity in the saliva, making smokers more susceptible to infection

Picture by Authority Dental under CC 2.0 license

Arginase is an enzyme that is found to be present in the saliva of smokers in higher concentration than in non-smokers. Scientists argue that it may cause lower nitric oxide production, which makes patients more prone to bacterial infection.

Infections lower the chances of implant survival. If they are left untreated they can also have catastrophic consequences for your general health.

#9: Studies link smoking to a weaker immune system, which makes fighting infection and healing more difficult

It may be surprising, but cigarette smoke can promote autoimmunity (fighting off conditions caused by our own body, e.g. celiac disease). On the other hand, it makes the immune system weaker against outside infections.

Smokers are more vulnerable to infections which can happen during the implant process. Their immune systems are incapacitated and it is harder for their bodies to fight those off. That is why symptoms such as implant pain are usually more severe and failure of implants increasingly likely.

#10: E-cigarettes also affect healing negatively after implant placement

Smoking is not only harmful to the healing process due to the smoke itself but also due to the nicotine content. The substance works to constrict capillaries preventing proper blood flow. This can impair recovery and bone growth, both very important processes in implant placement.

E-cigarettes may be less damaging to your lungs, but they still contain nicotine. This means they can prevent proper restoration of soft and hard tissues after surgery.