21 June 2023

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Influence of smoking on peri-implantitis

Lara Figini

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At present, several studies in the literature have shown that smoking is an important risk factor for periodontitis and associated tooth loss.

Smoking also increases the risk of both early and late implant failure and is associated with more postoperative infections and peri-implant marginal bone loss.

However, despite this topic having been debated for years, the evidence for smoking as a risk factor for peri-implantitis still remains inconclusive.

Materials and methods

In a review published online in Clinical Oral Implants Research in March 2023, the authors analyzed the influence of smoking on the incidence of peri-implantitis.

Researchers conducted a literature search through the National Library of Medicine (Medline-PubMed), Scopus, Embase and ISI Web of Science databases through Nov. 30, 2022.

The systematic review and meta-analysis were conducted according to the PRISMA statement. 

Two authors independently searched the literature for eligible studies evaluating the incidence of peri-implantitis in smokers and non-smokers, selected relevant titles and abstracts, and extracted data from the full text. They also conducted an analysis on risk of bias assessment. The results were summarized through random effects meta-analysis. The GRADE method was used to determine the certainty of the evidence.

Results

A total of seven studies with 702 patients and 1,959 implants were included for analysis. Different levels of smoking were reported in only one study, which classified patients as never-smokers, former smokers and current smokers.

Two studies defined limits regarding cigarettes smoked per day for patient inclusion: one considered only patients who smoked >10 cigarettes per day (Velasco-Ortega et al., 2021) and the other included only patients who smoked ≤10 cigarettes/day (Pozzi et al., 2015). 

All six studies included patients with a history of periodontitis.

Four studies presented the overall incidence of peri-implantitis at the patient level: 16% (Zhang et al., 2018), 18.7% (Windael et al., 2021), 32.07% (Swierkot et al., 2012 ) and 1.85% (Pozzi et al., 2015); five studies reported the incidence at the implant level: 11.2% (Zhang et al., 2018), 11.8% (Windael et al., 2021), 9.3% (Velasco Ortega et al., 2021) , 14.56% (Karoussis et al., 2003) and 0.84% (Pozzi et al., 2015).

The meta-analysis revealed a significant difference between smokers and non-smokers for the risk of peri-implantitis in implant patients (p < .0001) and for the patient-based analysis (p = .003). 

A strong association between smoking and the risk of peri-implantitis was verified at the implant level (RR: 2.04, 95% CI: 1.46-1.85) and at the patient level (RR: 2.79, 95% CI: %: 1.42-5.50).

Conclusion

From the data of this review, it can be concluded that smoking is associated with peri-implantitis at both the patient and implant level.

For more information: "The influence of smoking on the incidence of peri-implantitis: a systematic review and meta-analysis."