Effect of Smoking Habits on Accuracy of Implant Placement Using Mucosally Supported Stereolithographic Surgical Guides

Background: Smoking is considered as a factor for implant survival and peri‐implant bone loss of dental implants. Several studies revealed the negative effect of smoking on osseointegration and its dose‐related effect. Purpose: To evaluate the effect of smoking habits on accuracy of implant placement using mucosally supported stereolithographic surgical guides. Material and Methods: Six OsseoSpeed? implants (Astra Tech AB, Mölndal, Sweden) were inserted into the maxilla in 13 patients. Patients were excluded if they suffered from any systemic disease or if they were actually taking any kind of medication. Software (Mimics® 9.0) was used to fuse images of the virtually planned and actually placed implants, and locations and axes were compared between the nonsmoking and smoking subgroups. As the mucosal biotype could probably influence accuracy data, 12 reference points were defined within each patient to define a mean mucosal thickness value. Results: In the smoking subgroup, 36 implants were placed compared with 42 in the nonsmoking subgroup. Mean coronal deviation was 1.04 mm (range: 0.29–2.45 mm) among the smokers compared with 0.80 mm among the nonsmokers (range: 0.29–1.67 mm). At apical point, mean deviation was 1.26 mm (range: 0.39–3.01 mm) among the smokers compared with 1.02 mm among the nonsmokers (range: 0.32–2.59 mm). Mean angular deviation was 2.64° (range: 0.41–6.81°) among the smokers compared with 2.57° among the nonsmokers (range: 0.16°–8.86°). Significant differences were found when comparing global coronal and apical deviation between the smokers and the nonsmokers (p < .05). Evaluating mucosal thickness, mean value was 3.19 mm (range: 2.39–4.01 mm) among the smokers compared with 2.43 mm among the nonsmokers (range: 1.44–3.03 mm). Conclusions: Statistically significant differences were found when comparing the accuracy of dental implant placement of the smokers with the nonsmokers. Smokers have significant thicker supporting mucosal tissues compared with nonsmokers, which may explain inaccuracy due to less stability of the surgical guide or the scanning prosthesis.