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Dental Implants and Smoking

posted in Treatment Planning & Complications

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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.

21 Responses to “ Dental Implants and Smoking ”

• Alejandro Berg June 20th, 2006

  
  

  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

• W. Evans June 20th, 2006

  
  

  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.

• DR.M.ALI DDS MS June 20th, 2006

  
  

  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

• Alfred L. Heller DDS MS June 20th, 2006

  
  

  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

• Lance Stokes June 20th, 2006

  
  

  I think you guys are members of the pleasure police. If your work is good, then smoking will have no efect.

• Anonymous June 28th, 2006

  
  

  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.

• Jan Holmes July 16th, 2007

  
  

  A related question: does the use of nicotine replacement have the same deleterious effect on implant osseointegration and failure rate as smoking tobacco?

• Dr. Mehdi Jafari July 16th, 2007

  
  

  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.

• JW July 18th, 2007

  
  

  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.

• Steve October 16th, 2007

  
  

  Is it the tobacco products that cause the damage, or would other recreational smoking also be contra-indicated?

• bob July 9th, 2008

  
  

  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?

• Katie July 17th, 2008

  
  

  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.

• R. Hughes July 18th, 2008

  
  

  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!

• Jean July 19th, 2008

  
  

  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.

• ltj September 12th, 2008

  
  

  katie howd it go?

  mine is number 8 too

  shit let me know i have the same habits

• ltj September 12th, 2008

  
  

  and what about smoking prior to the implant going in, stopping 6 months before its put in, and not smoking during healing>?

• Jonathan P. March 1st, 2009

  
  

  Are the effects of smoking lessened after the healing? From what I have read it seems most of the risk comes when smoking during the healing process. Can I smoke after the implants are healed?

• Dr.Mehdi Jafari March 27th, 2009

  
  

  La toxicologie du tabac est relativement bien connue au niveau de ses conséquences pathologiques générales : cancers, bronchopneumopathies, maladies cardiovasculaires, dépendance neurologique. Cette toxicité est directement dépendante de la nature des substances chimiques produites par la combustion du tabac. La fumée de cigarette consiste en un mélange de gaz de combustion et de particules. La phase gazeuse est constituée essentiellement par le thiocyanate, et le monoxyde de carbone. La fumée étant acide, il n’y a presque pas d’absorption de celle-ci par la muqueuse buccale. La phase solide est essentiellement constituée par la nicotine. La nicotine, base faible et peu ionisée, est facilement absorbée par les muqueuses buccales et en 2 heures, elle est métabolisée en un certain nombre de métabolites dont le plus important est la cotinine, une substance cytotoxique et vaso-constrictrice. Localisation des récepteurs nicotiniques en dehors du système neuromusculaire. Le système neuromusculaire présente une affinité
  Particulière pour la nicotine. Mais des récepteurs nicotiniques sont aussi présents dans de nombreux autres tissus, en particulier les épithéliaux et les leucocytes. Dans le sang, les récepteurs sont présents dans les lymphocytes, les granulocytes, les macrophages et dans l’endothélium vasculaire. Enfin, la nicotine est cytotoxique pour la synthèse de collagène de type I par les fibroblastes. Cette polyvalence d’affinité de la nicotine pour divers tissus permet d’appréhender le tableau clinique multiforme qui se constate souvent chez les fumeurs.

• Richard Hughes DDS, FAAID, FAAIP, Dipl.ABOI/ID June 6th, 2009

  
  

  Jeff Large, I to live in Virginia. Virginia is a “Hang’em High State”. I am sympathetic to your problem. You took my comment all wrong. The issue is the condition in the mouth ie. the bone usually in a long term pain management patient is not of the proper density and the salivary flow is alot less. The salivary flow is necessary for decreasing decay etc. The saliva has antibodies in it which keep various organisms in low numbers , which cause various decay and gum infection issues. I have treated pain management patients before and I do not have a problem with them just so they are honest about the meds. Also pain management patients eventually develop a lower pain threshold. Plus, youn also have to realise that each and every Doc has to decide who they are going to treat. It’s on an individual basis.

• Manda September 22nd, 2009

  
  

  I am a smoker and I recently had an implant done on number 8. I never told my dentist that I smoked nor did he ask. Considering it was a friend of the family, they just assumed I did not. 3 months ago, I had Stage 1 performed. I did not know that I was supposed to stop smoking a month prior to Stage 1. The Dentist said it looked good as he monitored everything through X-Rays. I let it heal for a week and then continued to smoke. It was finals week and I pulled a week of all nighters and I gave in. Last Friday, I had Stage 2 performed. My Dentist told me that ‘it was an easy procedure’ so I didn’t think much about stopping smoking prior to the procedure. I did not even know that it was surgery. He told me that I would be in and out. I would have tried to stop smoking if I knew I was actually having the second stage of surgery. Now, I am not smoking cigarettes. I am currently chewing nicorette gum. Are my chances high of implant failure? Unfortunately, there was poor communication about smoking at my Dentist. I also read a journal on the internet and I thought I read that smoking does not directly correlate to the implant failure itself but other factors in combination with smoking does.

• PJ October 15th, 2009

  
  

  Very interesting thread.

  I visited my dentist today and am in need of an implant after a rather painful extraction. He said that it is best to get it done sooner than later as leaving it too long the bone softens and has less chance of bonding with implant.

  Anyway on to smoking. I am what you call a social smoker. Was quite open with him about this. He said that the fine nerve capillaries are damaged/affected by nicotine and this causes problems with the healing process. What was not clear is the damage done by smoking over the years. Hence my googling to find out the risk factors.

  I will not smoke from today up to the surgery and during the healing process - this can take up to four months before the implant is capped. It will be a complete waste of time having the implant if I am not willing to make that sacrafice.

  Thanks for those who have posted with wisdom, it seems clear that the main risk is smoking during the healing process (and perhaps just before). Good a time as any to give up completely.

  Now I need to google other possible risk factors; Bruxism (tooth clenching and grinding) which I suffer from and previous missuse of pain killers, I became a little addicted to an over the counter medicine Solpadeine.

  One thing for sure is that implants sure make you address your life style. The bottom line seems to be that the success rate is higher for people who are not only healthy, but have healthy lifestyles.

  thanks for posting all this information
  PJ

  and it is a great incentive to give up completely.and that smoking along with diabeties

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