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Dr. Jonas asks us:
I recently had a patient come in for a dental implant consultation. This patient is a smoker.
What is the optimum number of dental implants
(maxilary and mandib.) to support a full overdenture (no grafts involved), in
a smoker? Any other thoughts regarding the placement of dental implants in smokers. Thanks for your comments.
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14 Responses to “ Dental Implants and Smoking ”
If you want to live a relaxed life dont place implants on smokers…. if you want to go for the risky kind of life i would go for surface treated implants like rbm or so, in a 2 stage surgery and at least 6 implants for lower jaw and 8 for upper maxilla.
if he is a heavy smoker just dont.
good luck
I tell patients to quit smokinig one month before implant or bone graft surgery and tell them to not smoke again until they are healed. So far that has worked in patients who really want implants. If you must place implants then the more the better in case of failures and you should expect failures. I lost three out of four implants in the anterior mandible in a teenager who smoked during healing.
there is no contra indication for smoking and dental implant , hawever there are some riske factors such as smoking and drinking alcohols,auto immune deseases,radiations,ossious deseases etc.if you have a smoker needs dental implants ,you should have more precoutions in surgery to establish initial stability .for maxillary over denture ,you need 6 implants ,in your treatment plan you should do a design when you have all implant copings are attached together, for example:bar over denture,also put as many implant as possible in ant.maxilla. life expectation for post. maxilla is less. you have more luck in the mandible, again ant.mandible is preferable .4 to 6 implants will be o.k. for the lower arch. the important thing is to choose proper treatment plan and do diagnostic work up for that plan. informe your patient about the risks and the binifits, patient has to stop smoking during the psurgery and the integration period also smoking protection plate or full denture might help. good luck . from DR.ALI
I have taught over 535 Doctors the art of implant surgery and implant prosthetics together with simple and advanced bone grafting techniques teaching in eight universities over a period of 26 years. All these students are encouraged to not do implants or bone grafting on smokers as their failures are more severe and ruin your week of enjoying dentistry. We teach patients must quit smoking two months before treatment and one month after treatment. We check with their spouse to see if they have complied. If a patient can quit for three months they can quit. If they start smoking after implants have been placed it is written in the their record and explained to them in front of an assistant that their implants will fail with their smoking habit and they will be held totally financially responsible.
Alfred L. Heller DDS MS
Director, Midwest Implant Institute
www.midwestimplantinstitute.org
I think you guys are members of the pleasure police. If your work is good, then smoking will have no efect.
any comments on grafting with new human growth factor? (rhPDGF). The trail ( Dec. J Perio) included up to a pack a day smokers with little or no difference in outcome on 1-2 and 3 wall perio defects.
A related question: does the use of nicotine replacement have the same deleterious effect on implant osseointegration and failure rate as smoking tobacco?
Nicotine, no matter if it’s been injected, inhaled, swollen or transdermally absorbed, has been shown to increase platelet aggregation, decrease microvascular prostacyclin levels and inhibit the function of fibroblasts, erythrocytes and macrophages. This means that not only it seriously interferes with the osseointegration phase, but it always makes the implant vulnerable to peri-implantitis, crestal bone loss and the future failure as well.
Dr. Jonas: There is no “magic” number for number of implants, there is a higher risk for smokers for implant failure. You might want to read some of Georgia Johnson’s work about smoking and the periodontal patient and Schwartz-Arad’s papers. I think GJ has a protocol for cessation prior to implant placement. It is something like quit 7 weeks prior and 4 weeks post placement. (I can’t remember). I usually try to get them to quit, particularly in the maxilla. Implants are a nice carrot.
Jan Holmes: While Dr. Jafari is absolutely correct with regards to the mechanism of action of nicotine, there are 2 factors that must be considered when talking about smokers: the systemic effect of smoking and the localized effect of smoking. I’ll leave aside the systemic effects for now as Dr. Jafari summed it up quite nicely. Smoke in an of itself is harmful to the periodontium. It contains high levels of carbon monoxide and other things that decrease the healing response IN ADDITION to the deleterious systemic effects. Lambert, et al have a article about poor tissue response to smoke inhalation. Simply put…healthy patient good, nicotine replacement patient not so good(?), smoker bad. However, there really isn’t any literature about your questions specifically, everything is inferred from a body of evidence. You might want to ask Dr. Lance Holmes.
Lance: Your work is beautiful, it is better than time, literature and what every other health care provider on the face of the planet tells us…that smokers have a poor healing response. PLEASE write a paper and show me how to treat patients in a way that overcomes biology, I am just a mere mortal that needs help.
Is it the tobacco products that cause the damage, or would other recreational smoking also be contra-indicated?
What if someone has been smoking weed for extended periods of time since he got his bone graft? its been a couple years and ive had a bridge in until im finished growing.. im nervous that i’ll ruin everything cause of what i ve been doing the past couple years..
will i be ok if i stop months before the actual metal implant is put in?
I have an important question thats pretty urgent I suppose. I am a heavy marijuana smoker and an occasional cigerette smoker. I go in for implant surgery this Friday (tomorrow) and am pretty sure I never told my dentist Im a smoker. After reading this blog I am a little nervious now for this prodecure and my chances at a failiure. So my question is…
If i stop smoking… 100% no smoke whatso ever for a month or so after surgery during the healing process, am I still basically screwed and bound to have a failure?? The reason I am so nervious about this is because the implant is going in on my front tooth (#8) so its really important it looks nice.
Heavy smoking of anything is not good for healing and maintaining implants. Smoking grass raises some pain mamagement issues and potential addiction issues. I would not treat you!
A favorite dentist of mine told me that after dental procedures to take large doses of Vitamin C as it promotes healing. Since smoking depletes the body of Vitamin C, it makes good sense to take it, either in pill form or powder form. The sodium ascorbate form or calcium ascorbate form (powders) can be easily dissolved in juices or water.
I personally take about 8/10,000 mg. a day, throughout the day, since I, too, have the bad habit of smoking cigarettes.
I don’t know about the marijuana but it might help there, too. I hope that all goes well for you.
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