Review suggests that smoking may have a harmful effect on peri-implant bone loss


It is believed that a number of factors may affect peri-implant bone resorption. These may include local factors (e.g. surgical procedures, implant design and restorative procedures), or patient related factors such as systematic disease, smoking status etc.   The aim of this review was to determine the influence of patient-related systemic risk factors (systemic disease, genetic traits, chronic drug or alcohol consumption, and smoking status) on peri-implant bone loss at least 1 year after implant installation and prosthetic loading.

Searches were conducted in the Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled clinical trials, controlled clinical trials, cohort studies, case–control studies, and case series with at least five patients for dental implant studies presenting systemic risk factors (systemic disease, genetic traits, chronic drug or alcohol consumption, and smoking status). Only English language studies were included. Study identification and quality assessment was carried out by 2 reviewers.

  • 17 studies (1883 patients, 5730 implants) were included  (16 cohort studies and 1 randomized controlled trial (RCT).
  • 13 studies  (1685 patients) contributed to the meta-analysis
    • There was a high level of heterogeneity
    • the meta-analysis suggests that smoking has a harmful effect on bone loss
    • smoking increases the annual rate of bone loss by 0.164 mm/year.

The authors concluded

Within the limits of this study, it is possible to conclude that: (1) the level of evidence for oral implant therapy in patients with systemic conditions is very low. Generally, only case reports or case series exist reporting, at the least, the implant survival rate as an outcome. (2) Smokers presented a higher level of peri- implant bone loss (0.164 mm/year) than non-smokers. (3) The design of future studies should be improved to provide more robust data for clinical application.


This review only looked at English language studies so it is possible that additional relevant studies have been published. The majority of included studies are retrospective so have a greater risk of bias. The studies included in the meta-analysis show a high degree of heterogeneity and the authors themselves indicate the level of the available evidence is low.


Clementini M, Rossetti PH, Penarrocha D, Micarelli C, Bonachela WC, Canullo L. Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2013 Dec 24. pii: S0901-5027(13)01192-2. doi: 10.1016/j.ijom.2013.11.012. [Epub ahead of print] PubMed PMID: 24373525.


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