Impact of smoking on marginal bone loss

PURPOSE: To compare marginal implant bone loss (MBL), survival, and radiographic evidence of success of dental implants among smokers and nonsmokers. MATERIALS AND METHODS: Consecutive records of 161 patients (aged 23 to 89 years, mean 57 years) treated with a total of 646 implants between the years 1995 and 1998 were examined. Patients were divided into 3 groups: nonsmokers, moderate smokers, and heavy smokers. Tobacco exposure was calculated by cigarettes per day and by pack-years. Follow-up ranged from 1 to 7 years (mean 3.8 years). Postoperative panoramic radiographs obtained before implant exposure and annually thereafter were analyzed for MBL changes. The influence of smoking and other variables on MBL was analyzed at all implant sites. RESULTS: Generally, smokers had more MBL than nonsmokers (0.153 +/- 0.092 mm and 0.047 +/- 0.048 mm, respectively; P < .001). When each jaw was examined separately, smoking had a greater effect on MBL in the maxilla than in the mandible (0.158 +/- 0.171 mm versus 0.146 +/- 0.158 mm, respectively; P < .001). Furthermore, in the maxilla, heavy smokers had the greatest amount of MBL (0.1897 +/- 0.1825 mm), followed by moderate smokers (0.123 +/- 0.156 mm) and nonsmokers (0.0460 +/- 0.070 mm) (P < .001). In the mandible, there was no distinction between heavy and moderate smokers, and both had greater MBL than nonsmokers (P < .001). Only 3 of the 646 implants failed; the cumulative survival rate was 99.5%. Overall radiographic success rate was 93.2%. Nonsmokers had a higher radiographic success rate (97.1%) than smokers (87.8%) (P < .001). CONCLUSIONS: This study demonstrated a relationship between MBL and smoking habits. A higher incidence of MBL was found in the smoking group, and this was more pronounced in the maxilla.