Smoking and Dental Implants

As part of our In Depth series, Dr. Kylee Brightside discusses the impact that smoking can have on the success of dental implants.

Dental implants have a well-established history of high success rates.   Dental implants allow the patient to replace missing dentition to restore function and esthetics.  With proper maintenance, implants last for many years, however, one of the risk factors for implant failure is smoking.

Smoking has influence on the general health of the individual.  There is correlation between smoking and coronary disease, stroke risk, atherosclerosis, chronic obstructive pulmonary disease, pneumonia, low birth weight and cancers.  Smoking has its effects on oral health as well.  Smoking increases the risk of periodontal disease, oral cancer, root decay, delayed healing after surgery and implant failure.

The exact mechanism of how smoking compromises implants and healing is unknown.  However, studies have found smoking increases the expression of pro-inflammatory cytokines, which increases tissue damage and bone resorption.  Furthermore, nicotine has its own affect on the body.  Nicotine, a vasoconstrictor, has a negative impact on cellular protein synthesis and reduces the fibroblast’s ability to adhere thus directly interfering with wound healing.

There have been many studies showing the negative impact smoking has on implant success.  A retrospective multicenter study published in the European Journal of Oral Implantology, examined the 5-year success of implants comparing smokers vs nonsmokers.  They found smokers experienced almost twice as many implant failures compared to nonsmokers.  The complications such as significant marginal bone loss after implant placement, increased risk for developing deep mucosal pockets around implants, increased tissue inflammation and decreased success of bone grafts contribute to the failure rate.  Another study by Queiroz et al, examined salivary samples and determined smoking increases the salivary arginase activity, which may consequently increase the risk of bacterial infection and implant failures.

A study by Lindquist, found the quantity of smoking makes a difference in implant success.  The study found more marginal bone loss around the implants of heavy smokers (>14 cigarettes per day) than those with lower tobacco consumption.

Implants are not contraindicated in patients who smoke, as long as they understand the greater risk of failure and complication.  A recommended protocol for patients who smoke is to stop smoking at least one week prior to surgery to reduce some of the short-term effects from the nicotine.  Then the patient should avoid tobacco for at least 2 months after implant placement to reduce the risk.  After the implant is restored, it is imperative the patient maintain proper oral hygiene and recall appointments to monitor the implants.


  1. Bain CA. Smoking and implant failure- Benefits of a smoking cessation protocol. Int J Oral Maxillofac Implants. 1996; 11:756-9.
  2. Cavalcanti R, Oreglia, F., Manfredonia, MF., Gianserra, R., Esposito, M. The influence of smoking on the survival of dental implants: a 5-year pragmatic multicenter retrospective cohort study of 1727 patients. 2011; 4:39-45.
  3. Lambert PM, Morris HF, Ochi S. The influence of smoking on 3-year clinical success of osseoingrated dental implants. Ann Periodontol. 2000;5:79-89.
  4. Lindquist LW, Carlsson GE, Jemt T. Association between marginal bone loss around osseointergrated mandibular implants and smoking habits: A 10-yr follow up study. J Dent Res. 1997; 76:1667-74.
  5. Kasat, V., Ladda, R. Smoking and dental implants. J Int Soc prev Community Dent. 2012; 2:38-41.
  6. Queiroz DA, Cortelli JR, Holzhausen M, Rodrigues E, Aquino DR, Saad WA. Smoking increases salivary arginase activity in patients with dental implants. Clin Oral Investig. 2009; 13:263-7.


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