Currently little evidence to support smoking as a risk factor for peri-implantitis


Dental Implants are now seen as a predictable treatment strategy for restoration in the partially or totally edentulous patient. Peri-implantitis is one potential complication and the prevalence has been reported as ranging from 6 – 28%. Smoking has been identified as a potential risk factor. The aim of this review was to assess the evidence to ascertain whether smoking should be considered as a risk factor for peri-implantitis.

Searches were conducted in PubMed, Cochrane Register of Controlled Clinical Trials, Cochrane Database of Systematic Reviews, ISI Web of Knowledge, Science Direct, and Scopus. These were supplemented by searches in a range of relevant journals.  Only prospective cohort studies that compared smoking with nonsmoking patients and reported data on the incidence of peri-implantitis were selected. Study selection was conducted independently by two reviewers with quality being assessed using the Newcastle– Ottawa Scale.

  • Seven studies met the inclusion criteria, all 7 reported the definition of diagnostic criteria used for peri-implantitis but only 3 reported a clear definition of smoking
  • The patient-based analysis did not reveal any significant difference between smokers and nonsmokers for risk of peri- implantitis (RR: 1.17, 95% CI: 0.78–1.75, P = 0.46), with no evidence of heterogeneity (v2 = 2.44, P = 0.30; I2 = 18%).
  • The implant-based analysis revealed a higher and significant risk of peri-implantitis in smokers compared with nonsmokers (RR: 2.1, 95% CI: 1.34–3.29, P = 0.001), with no evidence of heterogeneity (v2 = 0.64, P = 0.89; I2 = 0%).

The authors concluded:-

There is little evidence that smoking is a risk factor for peri-implantitis. However, given the low number of included studies, future studies are needed to confirm these results.


Earlier this month we highlighted a review by Clementini et al (Dental Elf 22nd Jan 2014)  that looked at a range of systemic risk factors and their influence on peri-implant bone loss. That review suggested that smokers may be at greater risk of peri-implant bone loss.  This latest review focuses on peri-implantitis and did not find evidence to support a link.  While the implant-based analysis suggest an effect it is the patient based data that is most important here as the implants and not independent.


Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Smoking and the risk of peri-implantitis. A systematic review and meta-analysis. Clin Oral Implants Res. 2014 Jan 18. doi: 10.1111/clr.12333. [Epub ahead of print] PubMed PMID: 24438442.

Dental Elf  22nd Jan 2014  –  Review suggests that smoking may have a harmful effect on peri-implant bone loss

Dental Elf  13th May 2013  –  Only weak evidence available of the impact of smoking on survival of implants placed in augmented areas of maxillary sinus


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