Smoking and dental implants: A systematic review and meta-analysis

Objective: Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus nonsmokers, against the alternative hypothesis of a difference. Data: Main search terms used in combination: dental implant, oral implant, smoking, tobacco, nicotine, smoker, and non-smoker. Sources: An electronic search was undertaken in September/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. Study selection: Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 1432 publications, of which 107 were eligible, with 19,836 implants placed in smokers, with 1259 failures (6.35%), and 60,464 implants placed in nonsmokers, with 1923 failures (3.18%). Conclusions: The insertion of implants in smokers significantly affected the failure rates, the risk of postoperative infections as well as the marginal bone loss. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies. Clinical significance: Smoking is a factor that has the potential to negatively affect healing and the outcome of implant treatment. It is important to perform an updated periodic review to synthesize the clinical research evidence relevant to the matter. (C) 2015 Elsevier Ltd. All rights reserved.