Examining the Effect Smoking Has on Periodontal and Implant Therapy

Smoking is widely recognized as the most modifiable risk factor for periodontal disease. A recent narrative review aimed to emphasize the detrimental effects of smoking on periodontal and implant therapy. The authors reviewed existing literature to explore the clinical outcomes of smoking on periodontal surgical and nonsurgical treatments, as well as its impact on implant therapy and sinus lifting procedures.

The results of the review indicate that smoking significantly compromises the outcomes of periodontal and implant therapy. Smokers exhibit less favorable responses to periodontal treatment and periodontal flap procedures compared to nonsmokers. Clinical outcomes for smokers are reported to be 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth, a key indicator of periodontal disease severity, compared to nonsmokers. Furthermore, smokers demonstrate less bone growth following the treatment of infra-bony defects with guided tissue regeneration.

In the context of implant therapy, smoking poses a significant risk. The relative risk of implant failure is significantly higher in patients who smoke 20 or more cigarettes per day compared to nonsmokers. Additionally, smoking has been shown to increase the incidence of postoperative wound dehiscence and infection rates following sinus floor elevation procedures, a common technique used to prepare the site for dental implants.

However, the evidence regarding the long-term impact of smoking on peri-implantitis and implant loss remains insufficient. Further research is needed to fully understand the relationship between smoking and these specific complications.

Nevertheless, studies on smoking cessation have shown promising results. When smokers quit smoking, there is a reduction in probing depths and an improvement in clinical attachment after nonsurgical periodontal therapy. Longitudinal studies have demonstrated that bone loss and probing depths in periodontitis patients decrease after smoking cessation compared to those who continue smoking.

In conclusion, smoking has a detrimental impact on both periodontal and implant therapy. Smokers experience poorer outcomes in terms of periodontal disease progression and response to treatment, as well as higher risks of implant failure and postoperative complications. Smoking cessation plays a crucial role in improving the prognosis of periodontal disease and should be strongly encouraged. However, further research is needed to fully understand the long-term effects of smoking on implant therapy, including peri-implantitis and implant loss.