Dental Implants and Smoking

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.

31 thoughts on “Dental Implants and Smoking

  1. 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

  2. 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.

  3. 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

  4. 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
    http://www.midwestimplantinstitute.org

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

  6. 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.

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

  8. 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.

  9. 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.

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

  11. 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?

  12. 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.

  13. 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!

  14. 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.

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

  16. 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?

  17. 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.

  18. 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.

  19. 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.

  20. 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

  21. I wish I had been told about the problems with smoking. I left the Dentist office Saturday evening after my first 2 implants were started and I was still in a little bit of the sedation mode- but the Dentist just yelled to me as my Husband was helping me out of the door….are you a smoker? I said, yes, he said, don’t smoke! He didn’t give anymore details, so this is why I’m here!! I’m freaking out – had I known about this I would have tried to quit before or possibly had a bridge or something done. My treatment plan for everything I’m having done is over $19K! I can’t believe I was never asked if I was a smoker! I have been smoking lightly during the past couple of days…I hope it’s going to be okay.

  22. OK Maybe it’s just me but I am confused. My dentist did not require that I quit smoking prior to the implant surgery — the take home after care literature only said to “curtail” smoking — at the follow up appt he scared me by saying it is REALLY bad to smoke and he doesn’t want to have to remove the implant so QUIT. Jeez — now i’m chewing nicotine gum a couple of times a day and not smoking (day 1), Am I screwed anyway because I stopped too late? Should I be taking Vitamin C or more calcium? What can I do to improve my chances?

  23. Nicotine
    Nicotine is a powerful insecticide and poisonous for the nervous systems.
    Furthermore, there is enough (50 mg) in four cigarettes to kill a man in
    just a few minutes if it were injected directly into the bloodstream.
    Indeed, fatalities have occurred with children after they had swallowed
    cigarettes or cigarette butts.
    When diluted in smoke, nicotine reaches the brain in just seven seconds,
    it stimulates the brain cells and then blocks the nervous impulse. This is
    where addiction to tobacco arises. Nicotine also causes accelerated heart
    rate, but at the same time it leads to contracting and hardening of the
    arteries: the heart pumps more but receives less blood. The result is
    twice as many coronary attacks. Nicotine thus also increases the
    consumption of lipids (which is why it has a weight-loss effect) and
    induces temporary hyperglycaemia (hence the appetite suppressing effect).

    Carbon monoxide (CO)
    This is the asphyxiating gas produced by cars, which makes up 1.5% of
    exhaust fumes. But smokers inhaling cigarette smoke breathe in 3.2% carbon
    monoxide – and directly from the source.
    Oxygen is mostly transported in blood by haemoglobin. When we smoke,
    however, the carbon monoxide attaches itself to the haemoglobin 203 times
    more quickly than oxygen does, thereby displacing the oxygen; this in turn
    asphyxiates the organism. This causes the following cardiovascular
    complaints: narrowing of the arteries, blood clots, arteritis, gangrene,
    heart attack, etc. . . . but also a loss of reflexes and visual and mental
    problems. It takes between six and 24 hours for the carbon monoxide to
    leave the blood system.

    Irritants
    These substances paralyse and then destroy the cilia of the bronchial
    tubes, responsible for filtering and cleaning the lungs. They slow down
    respiratory output and irritate the mucus membranes, causing coughs,
    infections and chronic bronchitis.

    Tars
    As the cilia are blocked (see paragraph above), the tars in the cigarette
    smoke are deposited and collect on the walls of the respiratory tract and
    the lungs, and cause them to turn black. So, just because a smoker is not
    coughing, it doesn’t mean that he or she is healthy! And this fact merely
    serves to pour water on one of the most common and poorest excuses given
    by smokers. The carcinogenic action of the tars is well known: they are
    responsible for 95% of lung cancers. It takes two days at least after
    cessation of smoking for the cilia to start functioning properly again,
    albeit only gradually. By smoking one packet of cigarettes every day, a
    smoker is pouring a cupful of these tars into his or her lungs every year
    (225 grams on average)!

    Chemistry of Tobacco Smoke
    No less than 4000 irritating, suffocating, dissolving, inflammable, toxic,
    poisonous, carcinogenic gases and substances and even radioactive
    compounds (nickel, polonium, plutonium, etc.) have been identified in
    tobacco smoke. Some of these are listed hereafter: Benzopyrene,
    dibenzopyrene, benzene, isoprene, toluene (hydorcarbons) ; naphthylamines;
    nickel, polonium, plutonium, arsenic, cadmium (metallic constituents) ;
    carbon dioxide, methane, ammonia, nitric oxide, nitrogen dioxide,
    hydrogen sulphide (gases); methyl alcohol, éthanol, glycerol or glycerine,
    glycol (alcohols and esters); acetaldehyde, acrolein, acetone (aldehydes
    and ketones); cyanhydric or prussic acid, carboxyl derivatives (acids);
    chrysene, pyrrolidine, nicoteine, nicotinine, nicoteline, nornicotine,
    nitrosamines (alkaloids or bases); cresol (phenols), etc.

    Nicotine
    Nicotine is a powerful insecticide and poisonous for the nervous systems.
    Furthermore, there is enough (50 mg) in four cigarettes to kill a man in
    just a few minutes if it were injected directly into the bloodstream.
    Indeed, fatalities have occurred with children after they had swallowed
    cigarettes or cigarette butts.
    When diluted in smoke, nicotine reaches the brain in just seven seconds,
    it stimulates the brain cells and then blocks the nervous impulse. This is
    where addiction to tobacco arises. Nicotine also causes accelerated heart
    rate, but at the same time it leads to contracting and hardening of the
    arteries: the heart pumps more but receives less blood. The result is
    twice as many coronary attacks. Nicotine thus also increases the
    consumption of lipids (which is why it has a weight-loss effect) and
    induces temporary hyperglycaemia (hence the appetite suppressing effect).

    Carbon monoxide (CO)
    This is the asphyxiating gas produced by cars, which makes up 1.5% of
    exhaust fumes. But smokers inhaling cigarette smoke breathe in 3.2% carbon
    monoxide – and directly from the source.
    Oxygen is mostly transported in blood by haemoglobin. When we smoke,
    however, the carbon monoxide attaches itself to the haemoglobin 203 times
    more quickly than oxygen does, thereby displacing the oxygen; this in turn
    asphyxiates the organism. This causes the following cardiovascular
    complaints: narrowing of the arteries, blood clots, arteritis, gangrene,
    heart attack, etc. . . . but also a loss of reflexes and visual and mental
    problems. It takes between six and 24 hours for the carbon monoxide to
    leave the blood system.

    Irritants
    These substances paralyse and then destroy the cilia of the bronchial
    tubes, responsible for filtering and cleaning the lungs. They slow down
    respiratory output and irritate the mucus membranes, causing coughs,
    infections and chronic bronchitis.

    Tars
    As the cilia are blocked (see paragraph above), the tars in the cigarette
    smoke are deposited and collect on the walls of the respiratory tract and
    the lungs, and cause them to turn black. So, just because a smoker is not
    coughing, it doesn’t mean that he or she is healthy! And this fact merely
    serves to pour water on one of the most common and poorest excuses given
    by smokers. The carcinogenic action of the tars is well known: they are
    responsible for 95% of lung cancers. It takes two days at least after
    cessation of smoking for the cilia to start functioning properly again,
    albeit only gradually. By smoking one packet of cigarettes every day, a
    smoker is pouring a cupful of these tars into his or her lungs every year
    (225 grams on average)!

    Chemistry of Tobacco Smoke
    No less than 4000 irritating, suffocating, dissolving, inflammable, toxic,
    poisonous, carcinogenic gases and substances and even radioactive
    compounds (nickel, polonium, plutonium, etc.) have been identified in
    tobacco smoke. Some of these are listed hereafter: Benzopyrene,
    dibenzopyrene, benzene, isoprene, toluene (hydorcarbons) ; naphthylamines;
    nickel, polonium, plutonium, arsenic, cadmium (metallic constituents) ;
    carbon dioxide, methane, ammonia, nitric oxide, nitrogen dioxide,
    hydrogen sulphide (gases); methyl alcohol, éthanol, glycerol or glycerine,
    glycol (alcohols and esters); acetaldehyde, acrolein, acetone (aldehydes
    and ketones); cyanhydric or prussic acid, carboxyl derivatives (acids);
    chrysene, pyrrolidine, nicoteine, nicotinine, nicoteline, nornicotine,
    nitrosamines (alkaloids or bases); cresol (phenols), etc.

  24. This is a mass of over paranoid people. You don’t have to quit a month before treatment. Just don’t smoke during healing and you will be fine. Jesus Christ, relax.

  25. Last September(2010) I had an implant done. My dentist knew I was a smoker but never told me that I should quit! So, even on the day of the implant, I smoked! Everything looked like it was going as it should and healing well,until the tooth was actually put on 3 months later. Two days after the tooth was put on, there was movement and it felt like the tooth was a little “wobbly”. Went back to the dentist who proceeded to take the tooth off the implant as he could not understand why this tooth should have movement. When he went to take the tooth off, the whole implant came out! We could only come to one conclusion and that was because I smoked prior to and after the implant was done. Since I do not have kidney disease, am not on chemo, etc. etc. or any other reason that would cause a rejection, it was smoking!! Since then I have quit smoking and will be getting another implant done in 5 days! Please don’t be like me and smoke if you are considering an implant! Besides, it is a heck of a lot more healthy NOT TO SMOKE!! Hard, but worth it.

  26. I just had my second implant done July 25, 2011. My first one was five years ago almost to the day. I had a root canal eleven years ago and the tooth eventually broke. I had an abscess in the gum upper jaw #3 tooth, I had #4 done first. I quit smoking with the first one for approximately 1 year and started smoking again that tooth is well. I again stopped smoking for the second tooth implant and am hoping for the same result, I had 93% bone graft success. I think this time it will be for good. If not I wonder if the E-cigarettes are safe, if not quiting forever is the answer. Good luck to you guys, I am hoping for the best for you all.

  27. hi guys i have just had 1 implant and at the moment have an essex retainer until it heals-when does it heal and how long?

  28. If one has a successful dental implant and then (stupidly) begins smoking many years later, can this cause any complications? Or is it only when the implant is healing that smoking is an issue?

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