Only weak evidence available of the impact of smoking on survival of implants placed in augmented areas of maxillary sinus


Grafting to augment the floor of the maxillary sinus prior to placement of dental implants in the resorbed maxillary is an increasingly used technique. The aim of this review was to evaluate the effects of smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation.

Searches were conducted in Cochrane Oral Health Group’s Trials Register (CENTRAL), Medline, Embase and Open- Gray [], formerly OpenSIGLE). Observational (case–control and prospective cohort studies) and interventional (randomised controlled clinical trials, controlled clinical trials and case series) were considered for inclusion.  Study quality was assessed using an adapted version of the Newcastle–Ottawa scale (NOS).

  • 8 studies were included (7 case series, 1 randomised controlled trial).
  • 2 of the case series were prospective the remainder retrospective.
  • 7 studies contributed to a meta-analysis
  • The pooled analysis indicated that smokers lost more implants in grafted areas than non-smokers.
    • The relative risk (all 7 studies) was 1.87 [95% CI: 1.35, 2.58], P = 0.0001).
    • The relative risk (prospective studies only) 1.55 [95% CI: 0.91, 2.65], P = 0.11).

The authors concluded

Although smoking was associated with implant failure in most of individual studies and in the overall meta-analysis, the detrimental effect of smoking was not confirmed when only prospective data were assessed.


The authors note that the majority of the included studies were case series and retrospective, which have inherent methodological weaknesses. They also highlight issues in relation to graft materials used and the detailing and ascertainment of smoking status. Two previous reviews ( Hinode et al 2006,   Strietzel et al 2007 ) have also identified smoking as a risk factor for dental implant placement.


Chambrone L, Preshaw PM, Ferreira JD, Rodrigues JA, Cassoni A, Shibli JA. Effects of tobacco smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation: a systematic review. Clin Oral Implants Res. 2013 May 7. doi: 10.1111/clr.12186. [Epub ahead of print] PubMed PMID: 23651315.

Hinode D, Tanabe S, Yokoyama M, Fujisawa K, Yamauchi E, Miyamoto Y. Influence  of smoking on osseointegrated implant failure: a meta-analysis. Clin Oral Implants Res. 2006 Aug;17(4):473-8. Review. PubMed PMID: 16907781.

Strietzel FP, Reichart PA, Kale A, Kulkarni M, Wegner B, Küchler I. Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol. 2007 Jun;34(6):523-44. Review. PubMed PMID: 17509093.





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