Smoking and complications of endosseous dental implants

BACKGROUND: The purpose of this study was to compare the incidence of the complications and survival rate related to dental implants among smokers and non-smokers, and to evaluate the influence of smoking by analyzing data of 959 implants placed in 261 patients during the years 1995 to 1998. METHODS: Patients were divided into 3 groups: non-smokers, mild smokers (up to 10 cigarettes per day) and heavy smokers (more than 10 cigarettes per day); smokers were divided into 2 subgroups according to duration of smoking (less or more than 10 years). Complications included minor (spontaneous implant exposure), major (spontaneous implant exposure requiring surgical intervention), and implant failure. The influence of smoking was analyzed for the type of implant cover screw and immediate versus late implantation. RESULTS: The overall failure rate was 2% for non-smokers and 4% for all smokers. Minor and major complications were found in higher percentages (46%) in the smoking groups than in the non-smoking group (31%). A significantly higher incidence of complications was found among smokers who received dental implants with high cover screws (63%) compared to those who received dental implants with flat cover screws (27%). CONCLUSIONS: This study establishes a relationship between implant complications and smoking, implant type (external or internal hex), and time of implantation as significant factors. A higher incidence of complications was found in the smoking group, especially in implants that had a high cover screw. Most complications will not lead to failures. Immediate implants failed less frequently than non-immediate implants. Limiting or reducing smoking habits will decrease complications of endosseous dental implants.     

Effects of smoking on implant success in grafted maxillary sinuses.

STATEMENT OF THE PROBLEM: Cigarette smoking has been identified as a significant risk factor for dental implant treatment. PURPOSE: This retrospective study evaluated the effect of smoking and the amount of cigarette consumption on the success rates of the implants placed in grafted maxillary sinuses. MATERIAL AND METHODS: Sixty patients (16 smokers and 44 nonsmokers) were evaluated for the effects of smoking on osseointegrated implants placed in 84 grafted maxillary sinuses that contained a total of 228 endosseous root-form implants. Seventy implants were placed in 26 maxillary sinuses in smokers, whereas 158 implants were placed in 58 sinuses in nonsmokers. The number of implant failures and the amount of cigarette consumption were recorded. RESULTS: Of the 228 implants, 205 (89.9%) remained in function, after a mean follow-up period of 41.6 months (2 to 60 months). There was a significantly higher cumulative implant success rate in nonsmokers (82.7%) than in smokers (65.3%) (P =.027). Overall cumulative implant success rate was 76%. There was no correlation between implant failures and the amount of cigarette consumption (P >.99). CONCLUSION: Within the limitations of this study, cigarette smoking appeared to be detrimental to the success of osseointegrated implants in grafted maxillary sinuses regardless of the amount of cigarette consumption.     

Implant designs for the spectrum of esthetic and functional requirements

In recent years, attention has shifted from merely achieving successful osseointegration of dental implants to achieving proper esthetics that mimic natural dentition. Original implant designs were primarily developed for the treatment of fully edentulous patients where esthetics was not a major objective of the therapeutic outcome. During the initial years of the development of osseointegrated implants, greater emphasis was placed on achieving successful osseointegration. As the number of patients undergoing implant therapy, as well as the number of clinical indications for dental implants, is rapidly expanding, the therapeutic armamentarium also has to expand. The most important requirement for achieving predictable esthetic results is careful consideration of the biology of the interaction between the implant-prosthesis complex with the implant site. Only those implant-supported restorations that achieve harmony with the surrounding hard and soft tissues can be expected to have an optimal esthetic outcome will endure.     

The relationship between cigarette smoking and dental implant failure

This paper examines the effect of tobacco use on the failure rates of dental implants. A review of 56 dental implant patients with a total of 187 endosseous dental implants, placed over a four year period, demonstrated a significant association between increased implant failure rates and cigarette smoking with failure rates of 16.6% in smokers compared to 6.9% in non-smokers. Also implant length was shown to be a significant factor with shorter implants (< or = 10 mm) being more susceptible to failure in smokers. A chi-square test was used for data analysis. Current recommendations that should be given to implant patients who smoke are included.     

Dental implants in geriatric patients: a retrospective study of 47 cases

PURPOSE: To determine the overall success of dental implants placed in geriatric patients. PATIENTS: Dental implants were placed in 47 geriatric patients who were 79 or more years of age at the time of the procedure. The study group was composed of 27 men and 20 women, with a median age of 89 years and a range of 79 to 99 years of age at the time of implant surgery. A total of 73 dental implants were placed in the maxilla and 87 dental implants placed in the mandible. All implants were restored with fixed implant-supported prostheses or removable implant-supported prostheses. Eleven of the patients underwent maxillary sinus augmentation with porous hydroxyapatite and platelet-rich plasma. Seven patients had their implants immediately loaded. RESULTS: A total of 160 dental implants were placed in the 47 geriatric patients. One hundred fifty-nine integrated successfully. In the case of the failed implant, the site was grafted and another implant was placed 5 months subsequent to the initial failure. This replacement implant integrated and has been in function for 6 months. The survival rate for dental implants placed in the maxilla was 99% and in the mandible was 100% in our geriatric population. CONCLUSION: Treatment with dental implants can be predictable and safe for the rapidly growing geriatric population. Geriatric patients who are medically stable are suitable candidates for osseointegrated implant surgery, which facilitates oral function, comfort, and quality of life. A review of the 47 geriatric patients treated supports the conclusion that dental implants can be successfully placed and restored with fixed implant-supported or removable implant-supported prostheses.     

Dental implants in the diabetic patient: a retrospective study

It has become increasingly common for controlled diabetic patients to be considered as candidates for dental implants. This study reports on the results of placing implants in 34 patients with diabetes who were treated with 227 Br?nemark implants. At the time of second-stage surgery, 214 of the implants had osseointegrated, a survival rate of 94.3%. Only one failure was identified among the 177 implants followed through final restoration, a clinical survival rate of 99.9%. Screening for diabetes and trying to ensure that implant candidates are in metabolic control are recommended to increase the chances of successful osseointegration. Antibiotic protection and avoidance of smoking should also be considered.     

Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis

AIM: This systematic literature review was performed to investigate if smoking interferes with the prognosis of implants with and without accompanying augmentation procedures compared with non-smokers. METHODS: A systematic electronic and handsearch (articles published between 1989 and 2005; English and German language; search terms "dental or oral implants and smoking"; "dental or oral implants and tobacco") was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review. RESULTS: Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces. CONCLUSION: Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.     

Impact of IL-1 genotype and smoking status on the prognosis of osseointegrated implants

AIM: This study evaluated the impact of the IL-1 genotype and smoking status on the prognosis and development of complications of osseointegrated implants. MATERIAL AND METHODS: The clinical charts of 180 consecutively admitted patients were analyzed with respect to the occurrence of biological complications in conjunction with oral implants. Biologic complications were defined as clinical conditions with suppuration from the peri-implant sulcus, development of a fistula or peri-implantitis with radiologic bone loss. All patients had received one or more ITI dental implants, which had been in function for at least 8 (range: 8-15) years. This patient population had received 292 implants. From these, 51 implants in 34 patients showed late (infectious) biologic complications, and 241 implants had survived without any biologic complications at all. RESULTS: Of the 180 patients, 53 were smokers, who were subdivided in a series of classes according to their intensity of smoking and 127 were never smokers. Sixty-four of 180 (36%) patients tested positive for the IL-1 genotype polymorphism. This prevalence corresponds to previous reports for the prevalence of European descent populations. The results for the non-smoking group indicated no significant correlation between implant complications and a positive IL-1 genotype. However, there was a clear association for heavy smokers between a positive IL-1 genotype and implant complications. 6 of 12 or half of the heavy smokers and IL-1 genotype-positive patients had either an implant failure, i.e. loss of implant, or a biologic complication during the follow-up period. CONCLUSIONS: These findings have led to the conclusion that there is a synergistic effect between a positive IL-1 genotype and smoking that puts dental implants at a significantly higher risk of developing biologic complications during function.     

羟基磷灰石涂层种植体骨愈合的实验研究

目的：通过动物实验，研究涂覆烧结工艺技术研制的新型羟基磷灰石（HA）涂层种植体的骨愈合情况。方法：将12颗钛种植体（6颗有HA涂层，6颗无涂层）植入6只成年杂种犬下颌骨内，分别饲养1、3、6个月，使种植体在无负荷的条件下愈合。标本进行大体观察、光镜组织学观察以及计算机定量组织形态学评价。结果：两种种植体都能产生骨结合。有涂层的种植体新骨的产生和成熟都比无涂层的钛种植体更为迅速。术后1、3、6个月有涂层种植体的骨结合率分别为71．68％、86．81％、90．19％；无涂层种植体的骨结合率为53．26％、66．16％、68．72％，其间有显著性差异（P＜0．01）。结论：涂覆烧结工艺HA涂层骨内种植体能取得良好的骨结合，涂覆烧结工艺HA涂层能够很好地促进种植体的骨结合。     

Dental implants in reconstructed jaws: implant longevity and peri-implant tissue outcomes.

PURPOSE: The study aimed to evaluate the clinical status and survival of dental implants inserted in reconstructed jaws, with particular reference to the peri-implant tissues. MATERIALS AND METHODS: We conducted a clinical follow-up study based on 29 rehabilitated patients after oral tumor surgery, who received autogenous bone grafts from the ilium and endosseous implants (14 maxillary and 15 mandibular cases; 140 implants) for functional jaw reconstruction between 1988 and 1999. Clinical records of the patients were reviewed retrospectively. Clinical parameters of plaque index, probing pocket depth, and bleeding on probing were assessed around the implants and control teeth at 4 locations (mesiobuccal, distobuccal, mesiolingual, and distolingual). Implant mobility was assessed clinically and objectively using a Periotest (Gulden; Siemens, Bensheim, Germany) equipment for those implants supporting removable prostheses. Radiographically, the proportion of implant length remained osseointegrated was measured. RESULTS: With a mean follow-up time of 50 months, 90.7% of the 140 implants placed were functional in supporting dental prostheses; 4.3% of implants failed in osseointegration and the remaining 5.0% implants were osseointegrated but nonfunctional. A total of 493 sites of 127 functional implants and 392 sites of 98 control teeth were assessed. No significant difference was found between the implants and control teeth parameters, except on the probing pocket depth. The mean peri-implant probing depth was 3.5 mm, and 52.7% of the measured sites were 3 mm or less. More than one third of the implants (35.9%) presented with increased probing depth (> or =4 mm), and this was significantly higher than in the control teeth (P <.001, chi(2) test). Bleeding on probing was found in 19.3% of the measured peri-implant sites, corresponding to 42.2% of the dental implants. Of the implants, 28.9% were completely free from plaque and 9.4% show visible plaque accumulation. Mobility assessment was feasible on 32 implants and no mobility was detected. Radiographically, the mean implant length remained in bone was 81.1%, with 82.6% in the maxilla and 79.4% in the mandible. Implant survival rate calculated using the Kaplan-Meier method was 86.9% for 5 years. Based on the defined criteria, the success rate of implants placed in reconstructed jaws in this study was 90.7%. CONCLUSION: Endosseous implants can be successfully placed in reconstructed jaws for oral rehabilitation with maintenance of reasonable health status of the peri-implant tissues in the long-term.     

Proton Pump Inhibitors and the Risk of Osseointegrated Dental Implant Failure: A Cohort Study

Proton pump inhibitors (PPIs) have a negative impact on bone accrual. Because osseointegration is influenced by bone metabolism, this study investigates the association between PPIs and the risk of osseointegrated implant failure. This retrospective cohort study included a total of 1,773 osseointegrated dental implants in 799 patients (133 implants in 58 PPIs users and 1,640 in 741 non‐users) who were treated at the East Coast Oral Surgery Clinic in Moncton, Canada, from January 2007 to September 2015. Kaplan‐Meier estimator was used to describe the hazard function of dental implant failure by PPIs usage. Multilevel mixed effects parametric survival analyses were used to test the association between PPIs exposure and risk of implant failure adjusting for potential confounders. The failure rates were 6.8% for people using PPIs compared to 3.2% for non‐users. Subjects using PPIs had a higher risk of dental implant failure (HR = 2.73; 95% CI = 1.10–6.78) compared to those who did not use the drugs. The findings suggest that treatment with PPIs may be associated with an increased risk of osseointegrated dental implant failure.     

Private practice results of screw-type tapered implants: survival and evaluation of risk factors

PURPOSE: The aims of this study were to examine the long-term survival and the prosthetic treatment outcome of screw-type, tapered implants placed in a private practice setting and to explore potential risk factors of implant failures. MATERIALS AND METHODS: In this retrospective analysis of patients treated with endosseous screw-type tapered implants, data relative to implant placement and failure, implant length, location, prosthetic treatment, medical history, smoking habits, and oral health behavior were gathered by chart review and questionnaire. An oral examination was also conducted. Cumulative survival rates were estimated through Kaplan-Meier methods. Comparisons between subgroups of patients were made using the log-rank statistical test. The association between several factors and implant failures was analyzed using Cox regression analyses (random and dependent models). Differences were considered significant when P < .05. RESULTS: The survival rate of 663 implants placed in 159 patients (65 men, 94 women; 80.7% of 197 eligible patients) was 91.8% after 120 months. Mandibular implants had a higher survival rate than maxillary implants (96% versus 89%, P = .011). The failure rates for implants were 15.0% among current smokers, 9.6% among former smokers, and 3.6% among nonsmokers. The differences between nonsmokers, former smokers, and current smokers were significant (nonsmokers versus former smokers: P = .036, nonsmokers versus current smokers: P < .001, former smokers versus current smokers: P = .003). Only number of years of smoking was significantly associated with an increased risk of implant failures (P = .036 using dependent estimation; P = .004 using independent estimation). The HR increased to 6.6 for patients who had smoked for 45 years. Loosening of prosthetic components were rare (n=12). No fractures of screws or implants were found. DISCUSSION: Higher failure rates for former smokers and a dose-response effect between duration of smoking and implant failure rates suggested that permanent tissue damage from smoking may occur in addition to immediate local and systemic effects. The frequency of prosthetic complications was comparable to other studies. CONCLUSIONS: Screw-type tapered implants placed in a private dental office demonstrated a cumulative survival rate of 91.8%. The relative risk of implant failure increased with the duration of smoking.     

Effects of smoking on the outcome of implant treatment: a literature review.

STATEMENT OF PROBLEM: The use of osseointegrated implants as a foundation for the prosthetic replacement of missing teeth has become widespread in the last decade. Owing to the remarkable success of dental implants, there has been growing interest in identifying the factors associated with implant failure. Given the well-documented deleterious effect of smoking on wound healing after tooth extraction and its association with poor quality bone and periodontal disease, a negative effect of tobacco use on implant success is to be expected. PURPOSE: To establish the relationship between smoking and implant-related surgical procedures (i.e, sinus lift procedures, bone grafts and dental implants), including the incidence of complications related to these procedures and the long-term survival and success rates of dental implants among smokers and nonsmokers based on relevant literature.MATERIALS AND METHODS: Relevant clinical studies published in English between 1990 and 2006 were reviewed. The articles were located through Medline and, manually, through the references of peer-reviewed literature. This was supplemented with a hand search of selected dental journals and text books.RESULTS: The majority of the past and current literature implicates smoking as one of the prominent risk factors affecting the success rate of dental implants with only a handful of studies failing to establish a connection. Most of the studies report the failure rate of implants in smokers as being more than twice that in nonsmokers. These findings are difficult to ignore. There is a statistically significant difference between smokers and nonsmokers in the failure rates of dental implants. Smoking also has a strong influence on the complication rates of implants: it causes significantly more marginal bone loss after implant placement, it increases the incidence of peri-implantitis and affects the success rates of bone grafts. The failure rate of implants placed in grafted maxillary sinuses of smokers is again more than twice that seen in nonsmokers.Conclusion: Smokers have higher failure rates and complications following dental implantation and implant-related surgical procedures. The failure rate of implants placed in grafted maxillary sinuses of smokers is more than twice that seen in nonsmokers.     

The effect of smoking on osseointegrated dental implants. Part I: implant survival

PURPOSE: Recent studies implicate smoking as a significant factor in the failure of dental implants. The purpose of this long-term retrospective study was to evaluate the survival of Br?nemark endosseous dental implants in relation to cigarette smoking. MATERIALS AND METHODS: The sample consisted of 464 consecutively treated completely and partially edentulous patients who had a total of 1852 implants placed between 1979 and 1999, and who were part of a surgical/prosthodontic prospective treatment outcomes study. The effect of cigarette smoking on implant survival in relation to the time of implant failure, gender, age, surgeon, date and site of implant placement, implant length and diameter, prosthesis design, and occlusal loading considerations was assessed in bivariate and multivariate survival analyses. RESULTS: The overall implant failure rate was 7.72%. Patients who were smokers at the time of implant surgery had a significantly higher implant failure rate (23.08%) than nonsmokers (13.33%). Multivariate survival analysis showed early implant failure to be significantly associated with smoking at the time of stage 1 surgery and late implant failure to be significantly associated with a positive smoking history. Short implants and implant placement in the maxilla were additional independent risk factors for implant failure. CONCLUSION: Cigarette smoking should not be an absolute contraindication for implant therapy; however, patients should be informed that they are at a slightly greater risk of implant failure if they smoke during the initial healing phase following implant insertion or if they have a significant smoking history.     

Tobacco as a risk factor for survival of dental implants

BACKGROUND: It has been shown that smoking habits represent an increased risk for impaired bone healing and implant failure. This study aimed to evaluate the implant survival rates among non-smokers (NS) and different kinds of smokers (S). METHODS: A retrospective analysis was made over a 5-year period of the clinical and radiographic findings corresponding to 66 consecutive patients who had received a total of 165 dental implants. Patients were divided into two groups: S, 40 patients (95 implants; 58% of the sample); and NS, 26 patients (70 implants; 42% of the sample). Also, S and NS were classified into four different categories according to daily tobacco use: NS, 26 patients and 70 implants; light smokers (LS), 23 patients and 44 implants; moderate smokers (MS), 11 patients and 25 implants; and heavy smokers (HS), six patients and 26 implants. RESULTS: Sixteen implants (9.7%) failed and had to be removed. Group S showed 15 failures and a success rate of 84.2%. Group NS had only one failure, giving a success rate of 98.6%. The risk of implant failure was approximately 31% in those who smoked more than 20 cigarettes per day. HS showed statistical differences from NS or LS. However, they did not show any differences from MS. CONCLUSIONS: Within the limits of the present study, the use of tobacco involves a 15.8% risk of implant failure, with a 13.1 odds ratio. LS or MS tobacco use involves a 10.1% relative risk of implant loss, whereas the consumption of >20 cigarettes per day increases this risk to 30.8%.     

Effect of teeth with periradicular lesions on adjacent dental implants

OBJECTIVES: It is generally accepted that dental implants should not be placed in infected sites. However, the effect of periradicular infections of natural teeth on adjacent osseointegrated implants is less understood. The purpose of this study was to evaluate effects of periradicular lesions on osseointegration of existing implants.Study design Forty titanium solid root-form implants were placed close to premolars in dogs. After healing following implant placement, the adjacent premolars were treated in 1 of 4 ways: group A, no treatment of the adjacent premolar; group B, induction of a periradicular lesion followed by nonsurgical root canal therapy of the premolar; group C, induction of a periradicular lesion followed by nonsurgical root canal therapy of the premolar and surgical detoxification of the implant surface; and group D, induction of periradicular lesion and no treatment of the tooth. After 7(1/2) months, block sections were prepared and the percentage of osseointegration was analyzed histomorphometrically. RESULTS: The average integration for implants in groups A-B was 54%, 74%, 56%, and 68%, respectively. One-way analysis of variance demonstrated no difference between the 4 groups ( P =.518). CONCLUSIONS: The results of this study indicate that teeth with periradicular lesions do not adversely affect adjacent titanium solid root-form implants.     

Removable prostheses may enhance marginal bone loss around dental implants: a long-term retrospective analysis

BACKGROUND: The aim of the study was to retrospectively evaluate marginal bone loss (MBL) around rough-surface dental implants, placed in a private clinic, and to construct a multivariate model based on formerly proposed prognostic variables. METHODS: Records of patients who were treated previously with dental implants were reviewed. The patients' latest annual clinical examinations and radiograms were used for data collection and the calculation of MBL. A patient-based multivariate model was constructed based on two successive iterations of statistical analysis. RESULTS: Eighty-two patients and 265 implants with > or =30 months of follow-up were evaluated. The overall survival rate was 95.8% (2.6% early loss and 1.5% late loss). By evaluating the data with the single implant as a unit of analysis, MBL was correlated with time. Higher MBL values were found in smokers and around implants supporting removable prostheses. In the patient-based analysis, only smoking and the presence of a removable prosthesis correlated with higher values of MBL. Odds ratios for higher rates of MBL were 1.95 and 2.57 for smokers and around removable prostheses, respectively. Neither time nor any of the other suspected variables correlated with higher MBL. CONCLUSIONS: The present study corroborated the notion that smoking correlates with higher MBL and implied that implants supporting removable prostheses tend to display more bone loss. Further studies are needed to elucidate the latter finding.     

Healing in smokers versus nonsmokers: survival rates for sinus floor augmentation with simultaneous implant placement

PURPOSE: Evidence suggests that smoking is detrimental to the survival of dental implants placed in grafted maxillary sinuses. Studies have shown that improving bone quantity and quality, using rough-surfaced implants, and practicing good oral hygiene may improve outcomes. In this prospective study, the long-term survival rates of implants placed simultaneously with sinus grafting in smokers and nonsmokers were compared. MATERIALS AND METHODS: Implants with roughened surfaces were immediately placed into maxillary sinus grafts in patients with 1 to 7 mm of residual bone. A total of 2132 simultaneous implants were placed into the grafted sinuses of 226 smokers (627 implants) and 505 nonsmokers (1505 implants). A majority of the patients received a composite graft consisting of 50% autogenous bone. In both smokers and nonsmokers, approximately two thirds of the implants had microtextured surfaces; the remainder had hydroxyapatite-coated surfaces. The implants were restored and monitored during clinical follow-up for up to 9 years. RESULTS: Cumulative survival of implants at 9 years was 97.9%. There were no statistically significant differences in implant failure rates between smokers and nonsmokers. DISCUSSION: Implant survival was believed to depend on the following aspects of the technique used: creation of a large buccal window to allow access to a large recipient site; use of composite grafts consisting of at least 50% autogenous bone; meticulous bone condensation; placement of long implants (i.e., 15 mm); use of implants with hydroxyapatite-coated or microtextured surfaces; use of a membrane to cover the graft and implants; antibiotic use and strict oral hygiene; use of interim implants and restricted use of dentures; and adherence to a smoking cessation protocol.     

Early implant failures in patients treated with Brånemark System titanium dental implants: a retrospective study

Implant failure has been associated with factors such as poor bone quality, insufficient bone volume, implant instability, unfavorable implant loading, and smoking habits. Infections and host responses may also be important factors in dental implant failure. The objectives of the present study were to identify various explanatory factors associated with titanium implant failure. Forty subjects with stage 1 non-osseointegrated titanium dental implants (NOTI) ad modum Br?nemark and 40 age- and gender-matched control subjects with successfully osseointegrated titanium implants (SOTI) were studied. Clinical data and gamma G immunoglobulin (IgG) antibody titers were studied. An independent t test revealed that significantly longer implants were placed in subjects with SOTI (P < .05). Statistically significant differences in bone shape and resorption (BSR) scores were found between SOTI and NOTI (P < .05). Logistic regression analysis identified 3 significant explanatory outcome variables: serum antibody avidity scores for Bacteroides forsythus (P < .0001), serum antibody titers to Staphylococcus aureus (P < .001), and the BSR scores (P < .05). Antibody avidity to B forsythus and antibody titer to S aureus were therefore the 2 most important factors associated with early implant failures and with a significant predictive ability. This indicates that immunologic factors are involved in osseointegration.