25 May 2023

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Peri-implant inflammation in waterpipe users and cigarette smokers

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Objective

The aim of this study was to compare peri-implant clinical and radiographic status and levels of advanced glycation endproducts (AGEs) in peri-implant sulcular fluid (PISF) in waterpipe users and cigarette smokers.

Combustible tobacco products are commonly smoked in the form of cigarettes. It is often demanding for cigarette smokers to quit smoking, as nicotine is addictive, and its withdrawal elicits unpleasant symptoms including state of confusion or nervousness, headache, and constipation.

Other modes of combustible tobacco product usage include the use of cigars, pipes, and waterpipes (also known as shisha, hookah, and narghile). Waterpipe usage is a traditional norm in Middle Eastern countries including Saudi Arabia, Qatar and Kuwait.

However, studies have reported that waterpipe usage is increasing in other countries including Brazil, the U.S., the United Kingdom and Australia.

Methods

Waterpipe users, cigarette smokers, and never smokers were included.

Self-reported current cigarette smokers, waterpipe users and never smokers having undergone dental implant therapy for oral rehabilitation were included. Current cigarette smokers were defined as individuals who had a smoking history of at least five pack-years. Current waterpipe users were defined as those who used a waterpipe at least once a day in the past four weeks. Never smokers were defined as individuals who had never used any type of nicotinic product and had never tried vaping/electronic nicotine delivery systems.

Demographic details were collected using a questionnaire. Characteristics of implants (dimensions, jaw location, depth of placement, insertion torque, and duration in function) were recorded. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD), and crestal bone loss (CBL) were recorded in all groups. Volume of PISF and levels of AGEs were determined using standard techniques. Sample-size estimation was done on data from a pilot investigation, and correlation between clinicoradiographic and immunoinflammatory parameters was assessed using logistic regression models. Probability values <.05 were considered statistically significant.

Results

In all, 25, 25, and 24 cigarette smokers, never smokers, and waterpipe users, respectively, were examined. All participants were male and had comparable mean ages. Cigarette smokers and waterpipe users had a smoking history of 20.2 ± 3.5 years and 18.8 ± 0.6 years, respectively. The mPI (P < .01), CBL (P < .01), PD (P < 0.01), and mGI (P < .01) were significantly higher in cigarette smokers and waterpipe users than never smokers. There was no significant difference in clinicoradiographic status and AGE concentrations in waterpipe users and cigarette smokers. A statistically significant correlation was recorded between AGEs and PD in cigarette smokers (P < .01) and waterpipe users (P < .01).

Conclusions

Waterpipe usage is not less hazardous to peri-implant tissue health than conventional cigarette smoking. It is imperative to caution patients with dental implants about the detrimental effects of tobacco products on oral health.