The long-lasting effects of smoking on our implants …
PD Dr. Kristina Bertl, PhD MSc MBA
In a previous report (‘The long-lasting effects of smoking on our teeth ...’), we looked at studies on the long-lasting negative effects of tobacco consumption on the periodontium and periodontitis in particular. This report very effectively demonstrated the length of time that regular tobacco consumption can continue to have a negative effect on teeth, even after an individual has stopped smoking. Specifically, the risk of periodontitis-related tooth loss only decreased by approximately 6% per year after an individual stopped smoking. This means it takes approximately 15 years before the periodontitis-related rate of tooth loss among former smokers is comparable to that among non-smokers.
But what is the situation with implants and peri-implant diseases? We know from a previous systematic review that peri-implant diseases occur up to around 25% more frequently in smokers (Casado et al. 2019). A recent study by a Brazilian research group (Costa et al. 2022) looked at this subject again and investigated it in a fascinating way. Based on the data from 350 patients, who had all had at least one implant for at least five years, dividing them into three groups (non-smokers, former smokers and smokers) yielded the following results:
- The prevalence of periimplantitis was 18, 20 and 31% respectively in the groups of non-smokers, former smokers and smokers, making it 50% higher for smokers!
- Following a statistical correction for various potential influencing factors, the smokers were 2.6 times more likely to have periimplantitis than non-smokers. And even the former smokers were 30% more likely to suffer from periimplantitis than non-smokers.
- The risk rose even higher with higher levels of tobacco consumption – therefore proving a dose-dependent effect. So those smokers with > 40 pack years had twice as high a prevalence of periimplantitis than smokers with ≤ 20 pack years.
- The longer the length of time that the former smokers had successfully given up smoking, the lower their risk of periimplantitis. However, it was not until more than five years after stopping smoking that a former smoker's risk of periimplantitis decreased significantly compared to that for smokers.
While this study reinforces some of what we know already, it also provides us with useful data that we can use to give our patients additional arguments and reasons why they should stop smoking in order to look after their teeth and their implants.
- Priscila Ladeira Casado, Telma Aguiar, Marina Prado Fernandes Pinheiro, Aldir Machado, Aristides da Rosa Pinheiro. Smoking as a Risk Factor for the Development of Periimplant Diseases. Implant Dent. 2019 Apr;28(2):120-124. Fernando Oliveira Costa, Eugênio José Pereira Lages, Sheila Cavalca Cortelli, José Roberto Cortelli, Gustavo Henrique Mattos‐Pereira, Rafael Paschoal Esteves Lima, Luís Otávio Miranda Cota. Association between cumulative smoking exposure, span since smoking cessation, and peri‐implantitis: a cross‐sectional study. Clinical Oral Investigations (2022) 26:4835–4846.