|Year : 2017 | Volume
| Issue : 1 | Page : 24-27
Comparative evaluation of effect of smoking on survival of dental implant
Arpana Arora1, Madhan Mohan Reddy2, Swapnil Mhatre3, Aashima Bajaj4, PV Gopinath5, Prasad Arvind6
1 Department of Prosthodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Narayana Dental College, Nellore, Andra Pradesh, India
3 Department of Pediatric Dentistry, RR Dental College, Udaipur, Rajasthan, India
4 Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
5 Department of Periodontics, Malabar Dental College and Research Center, Edappal, Kerala, India
6 Department of Prosthodontics, MES Dental College, Malappuram, Kerala, India
|Date of Web Publication||28-Feb-2017|
Department of Prosthodontics, ITS Dental College, Greater Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Aims and Objectives: Osseointegrated implants are used in replacement of missing teeth. Survival rate of implant depends on many factors including oral hygiene, implant material used, bone quality, and personal oral habit such as smoking. The present retrospective research was conducted to assess the effect of smoking on survival of dental implant. Materials and Methods: The study participants were selected from all the patients who underwent for dental implant in implant center from 2005 to 2015. For each patient, various information regarding implant characteristics and smoking habits were recorded. The readings were statistically evaluated by SPSS statistical software by IBM version 21 and using Chi-square test at P ≤ 0.01. Results: In our study, the age range of patients was between 30 and 54 years. There were 2142 (57.2%) male and 1579 (42.4%) female participants, in that 72.2% were nonsmokers and 27.7% were smokers. Implant placed more in mandible (2312, 62%) than in maxillary region (1409, 37.8%). From 3721 patients, 3600 were successful and 121 failures. Success of implant was considerably more in nonsmokers than smokers. Implant failure rate was more in smokers with increased frequency and duration of cigarette smoking habit, but it was statistically not significant. In the present study, we have observed 0.049% mobility in smokers compared to 0.007% in nonsmokers. Conclusion: The present study showed that higher risk of implant failure was associated with long term and increased frequency of smoking due to bone resorption.
Keywords: Dental implant, failure, mobility, smoking
|How to cite this article:|
Arora A, Reddy MM, Mhatre S, Bajaj A, Gopinath P V, Arvind P. Comparative evaluation of effect of smoking on survival of dental implant. J Int Oral Health 2017;9:24-7
|How to cite this URL:|
Arora A, Reddy MM, Mhatre S, Bajaj A, Gopinath P V, Arvind P. Comparative evaluation of effect of smoking on survival of dental implant. J Int Oral Health [serial online] 2017 [cited 2019 Aug 25];9:24-7. Available from: http://www.jioh.org/text.asp?2017/9/1/24/201094
| Introduction|| |
An osseointegrated implant used to replace missing teeth is gaining widespread public demand. These implants are made up of biocompatible materials. Several authors have reported the long-term success of implant treatment; however, still implants are prone for failure which creates problem to dentist as well as patients. In general, implant failure is defined as the mobility of the implant during osseointegration or postoperative loading. The risk factors for implant are due to surgical procedure (type of implant, location, time lapse between tooth removal and implant placement, and loading) and patient characteristics (smoking, oral hygiene, uncontrolled diabetes, and alcohol consumption)., Success rate of implant depends on many factors including oral hygiene, operator skill, implant material (type and length) used, bone quality and quantity, occlusal load, absence of medical conditions, and personal oral habit such as smoking.,, For implant success, immunological and genetic factors such as tumor necrosis factor-α and interleukin-1β have been recognized as markers. Previously, success of implant was assessed by the absence of mobility and apical radiolucency. However, presently, the width of the attached gingiva, associated medical problems, smoking, and width of the implant can be considered as key factors in assessing the success of implant. Goutam et al. from the systematic review observed that smokers have greater chances of implant failure and complications compared to nonsmokers.
Studies have shown that smokers have a higher risk of periodontal disease, loss of tooth, and oral cancer. It has been observed that smoking is associated with decreased bone height, bone loss, poor bone quality, and peri-implantitis. Bain and Moy concluded that both systemic and local injury to the tissues occurs with smoking and which is a common cause for decrease in tissue oxygenation, which intern affects wound healing. Heitz-Mayfield and Huynh-Ba from systematic review found an increased risk of peri-implantitis in smokers over nonsmokers.It has been observed that 1.69 times greater implant failures in smokers than in nonsmokers. Increased quantity and duration of smoking increase the risk of implant failure. Nicotine content of tobacco is the major factor which affects bone health and cellular proliferation. DeLuca et al. from their 10-year follow-up study found significantly higher failure rate in smokers than nonsmokers. However, some authors stated that smoking is not considered as an absolute contraindication in dental implant cases.
The present retrospective study was done to assess the effect of smoking on survival rate of dental implant.
| Materials and Methods|| |
For the present retrospective study, participants were selected from all the patients who underwent for dental implant procedures in implant center from June 2005 to August 2015. For each patient, detailed information regarding implant characteristics (implant type, region, implanted jaw, bone augmentation, and bone quality) was obtained. Informed consent was obtained from all participants, and ethical approval was obtained from review board. Three thousand seven hundred and twenty-one participants were selected for the prospective study by simple random method and divided into Group I and Group II. The age range of patients was between 30 and 54 years. After the study, it was divided into either smokers (Group I) or nonsmokers (Group II) based on the history of smoking habit. Smoking characteristics such as type, number of cigarette smoking per day, and year of smoking on implant-treated patients were recorded based on self-administered questions.
Patients having missing teeth along with sufficient bone thickness for placement of implant were selected for the study, whereas patients with systemic conditions, psychological problems, radiation history, and cases requiring bone grafts were excluded from the study. Three skilled prosthodontists placed all dental implants in implant center. All patients after implant placement underwent periodic checkups in the implant center. Implant success was evaluated based on clinical (mobility) and radiographic findings. Implant status was evaluated during each visit. The implant status was defined either as survival or failure. Survival was defined when an implant was satisfactorily functioning with no evidence of pain, suppuration, or inflammation; otherwise, it was defined as failure.
The data were statistically analyzed using SPSS statistical software from IBM version 21 (IBM Corp., Armonk, NY) and using Chi-square test. Chi-square test was used to assess the relationship between each of the variables and implant failures. The association between smoking and implant failure was also evaluated.
| Results|| |
In the present study, the age range of patients was between 30 and 54 years. There were 2142 (57.2%) male and 1579 (42.4%) female participants, in that 72.2% were nonsmokers and 27.7% were smokers. Implant placed more in mandible (2312, 62%) than in maxillary region (1409, 37.8%) [Table 1]. From 3721 patients, 3600 were successful and 121 were failures. Success of implant was considerably more in nonsmokers than smokers. Implant failure rate was more in smokers with increased frequency and duration of cigarette smoking habit, but it was not statistically significant [Table 2]. [Table 3] indicated the role of mobility in success of dental implant.
|Table 1: Demographic profile with respect to gender, jaw type, and smoking habit|
Click here to view
|Table 2: Smoking habit in relation to implant survival over number of cigarette/day and year of smoking habit|
Click here to view
|Table 3: Implant mobility with respect to smoking habit (number of cigarette/day and year of smoking habit)|
Click here to view
| Discussion|| |
In the present study, dental implants were placed on 3721 patients in various locations of maxillary and mandibular region in patients with age range between 30 and 54 years. The study evaluated the influence of smoking habit on success of implants.
In the present study, there were 2142 (57.2%) male and 1579 (42.4%) female participants, in that 72.2% were nonsmokers and 27.7% smokers. Implant placed more in mandible (2312, 62%) than in maxillary region (1409, 37.8%) [Table 1].
From 3721 patients, 3600 were successful and 121 were failure. Success of implant was considerably more in nonsmokers than smokers, and implant failure rate was more in smokers with increased frequency and duration of cigarette smoking, but it was statistically not significant. We have evaluated the effect of cigarette on implant success for <20 and >20 packets daily for a period of over or <10 years [Table 2].
Similar to our results, Shenava et al. observed higher implant failure rate in smokers (63.63%) compared to nonsmokers (36.37%) and concluded that smoking is not contraindicated, but its adverse effects should be informed to patients. Similar conclusions were made by Takamiya et al. from a systematic review. Bain and Moy from meta-analysis compared implant success among smokers over nonsmokers, and they found 11.28% failure in smokers compared to 4.76% in nonsmokers which is in accordance with our study.
Shenava et al. found 69.05% survival of implant in patients with >10 years over 30.95% in <10 years smoking habit. They also observed that failure was higher with cigarette consumption >20 packets/year than <20 packets/year, which was statistically nonsignificant and concluded no significant difference between smokers and nonsmokers. We found increased failure rate of implant in patients with cigarette smoking >20 packets/day as well as in patients with >10 years of smoking history, this is similar to study by Twito and Sade.
Sun et al. and Lima et al. from their study observed decrease bone healing in smokers over nonsmokers., Bezerra Ferreira et al. concluded that cigarette smoking has a significant role on early bone tissue response around sandblasted acid-etched implant surface. It can be considered that bone loss around the implant can result in implant mobility. In the present study, we have observed 0.049% mobility in smokers compared to 0.007% in nonsmokers. Increased mobility was associated with increased frequency of smoking per day and duration >10 years [Table 3]. Shibli et al. concluded that smoking has a significant effect on bone healing around dental implant. Nogueira-Filho Gda et al. observed negative effect of marijuana smoke inhalation on implant success. Peleg et al. compared long-term success rate of implant placed simultaneously with sinus grafting in smokers over nonsmokers and observed no significant implant failure rate between two groups. Twito and Sade similar to our study observed higher implant failure rate among smokers (5.6%) compared to nonsmokers (3.5%), P < 0.001. It has been observed from earlier studies that higher implant failure in maxillary than mandibular jaw.
Bone healing around implant involves coordination of synthesis and activation of growth factors, matrix proteins, antigenic stimulation, and cytokines in restoration of bone around peri-implant interface. The exact mechanism by which smoking affects in implant failure is still not understood. It has been stated that cigarette smoking affects cell differentiation of pluripotent mesenchymal cells into osteoblast and fibroblast and thus healing of bone and implant interface can be impaired. The cigarette has >400 bioactive compounds, in that nicotine is the major compound which affects bone healing. There is a high nicotine permeability of gingival epithelium around the dental implant, and thus osteoblastic activity is hampered. Nicotine decreases proliferation of macrophages, and defensive mechanism of neutrophils and monocytes thus increases chances of infection at surgical region of implant placement., Smoking can affect osseointegration by lowering blood flow rate due to increased peripheral resistance and platelet aggregation.
Some studies stated that complete cessation of cigarette smoking habit can reverse its negative effect on implant., It has been observed that roughened titanium surface has better gingival cell adhesion than smooth surface and increasing surface roughness increases calcium and phosphate deposition, thus increases implant success rate.,
The primary outcome of the clinical study was (1) implant failure was more among smokers compared to nonsmokers, (2) higher implant failure with increased cigarette smoking frequency (>20 packets/day), and (3) increased risk with increased duration of smoking (over 10 years of duration).
The present study lacks long-term clinical study with larger sample size to prove the adverse effect of smoking on dental implant failure. Further clinical and histochemical research should be carried out to evaluate adverse effect of cigarette on implant and bone healing.
This research data help to identify the risk factor of smoking habit on oral health and implant success which can be used to educate the patients to quit the habit. Government organization can use these databases for implementation in health policies. Patients should be educated about the adverse effect of cigarette smoking and advise to stop the smoking habit, maintain strict oral hygiene to improve oral and general health. Patients are advised to stop smoking habit at least 2 weeks before implant surgery to allow recovery of normal blood viscosity and platelet adhesion.
| Conclusion|| |
The present study showed that longer duration and increased frequency of smoking were associated with decreased implant survival rate compared to nonsmokers, but it was not statistically significant. Patients should be informed about the harmful effect about tobacco smoking.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Takamiya AS, Goiato MC, Gennari Filho H. Effect of smoking on the survival of dental implants. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014;158:650-3.
Shenava S, Singh P, Sharath Babu C, Kumar V, Jyoti B, Sharma S. Co-relation between smoking and bone healing around dental impants: A clinical study. J Int Oral Health 2016;8:1-3.
Goutam M, Singh M, Patel D. Effect of smoking on the success of dental implant: A literature review. Int Dent J Stud Res 2003;1:44-50.
Twito D, Sade P. The effect of cigarette smoking habits on the outcome of dental implant treatment. PeerJ 2014;2:e546.
Palma-Carrió C, Maestre-Ferrín L, Peñarrocha-Oltra D, Peñarrocha-Diago MA, Peñarrocha-Diago M. Risk factors associated with early failure of dental implants. A literature review. Med Oral Patol Oral Cir Bucal 2011;16:e514-7.
Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. Int J Oral Maxillofac Implants 1993;8:609-15.
Heitz-Mayfield LJ, Huynh-Ba G. History of treated periodontitis and smoking as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24 Suppl: 39-68.
DeLuca S, Habsha E, Zarb GA. The effect of smoking on osseointegrated dental implants. Part I: Implant survival. Int J Prosthodont 2006;19:491-8.
Sun C, Zhao J, Jianghao C, Hong T. Effect of heavy smoking on dental implants placed in male patients posterior mandibles: A prospective clinical study. J Oral Implantol 2016;42:477-83.
Lima LL, César Neto JB, Cayana EG, Nociti FH Jr., Sallum EA, Casati MZ. Parathyroid hormone (1-34) compensates the negative effect of smoking around implants. Clin Oral Implants Res 2013;24:1055-9.
Bezerra Ferreira JD, Rodrigues JA, Piattelli A, Iezzi G, Gehrke SA, Shibli JA. The effect of cigarette smoking on early osseointegration of dental implants: A prospective controlled study. Clin Oral Implants Res 2016;27:1123-8.
Shibli JA, Piattelli A, Iezzi G, Cardoso LA, Onuma T, de Carvalho PS, et al.
Effect of smoking on early bone healing around oxidized surfaces: A prospective, controlled study in human jaws. J Periodontol 2010;81:575-83.
Nogueira-Filho Gda R, Cadide T, Rosa BT, Neiva TG, Tunes R, Peruzzo D, et al. Cannabis sativa
smoke inhalation decreases bone filling around titanium implants: A histomorphometric study in rats. Implant Dent 2008;17:461-70.
Peleg M, Garg AK, Mazor Z. Healing in smokers versus nonsmokers: Survival rates for sinus floor augmentation with simultaneous implant placement. Int J Oral Maxillofac Implants 2006;21:551-9.
Correa MG, Gomes Campos ML, César-Neto JB, Casati MZ, Nociti FH, Sallum EA. Histometric evaluation of bone around titanium implants with different surface treatments in rats exposed to cigarette smoke inhalation. Clin Oral Implants Res 2009;20:588-93.
César-Neto JB, Benatti BB, Sallum EA, Sallum AW, Nociti FH Jr. Bone filling around titanium implants may benefit from smoking cessation: A histologic study in rats. J Periodontol 2005;76:1476-81.
Kasten FH, Soileau K, Meffert RM. Quantitative evaluation of human gingival epithelial cell attachment to implant surfaces in vitro
. Int J Periodontics Restorative Dent 1990;10:68-79.
[Table 1], [Table 2], [Table 3]