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Effects Of Smoking

Effects Of Smoking 2015

A literature review on effects of smoking on the success of dental implants

According to World Health Organization (WHO) Global burden disease report, 2004, The WHO estimates that tobacco caused 5.4 million deaths in 2004 and 100 million deaths over the course of the 20th century. Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide".

Studies suggest that smokers have an increased prevalence of periodontal diseases, tooth loss, and oral cancer. There are several studies associating implant failures with smoking. This suggested that smoking caused both systemic and local injury to the tissues and is a common contributor to decrease tissue oxygenation, which negatively affects wound healing.

Nicotine presents as a main element of cigarette reduces proliferation of RBC, macrophages, and fibroblast which are the main element of healing. It also increases platelet adhesiveness which can lead to poor perfusion due to micro clots. It also acts as sympathomimetics by increasing the release of epinephrine and nor epinephrine and causes increased vasoconstriction which limits over all tissue perfusion. These all studies hypothesized that smoking compromises wound healing.

There are many studies showing smoking impairs bone wound healing and cause clear detriment to the skeletal tissues. Smoking is also found to be associated with osteoporosis as well as with reduced bone density in femur, vertebra and jaw bone, and decreases in the bone mineral content found in the smokers than compared to nonsmokers. Smoking effect on bone regeneration is established by studies that found success of bone regeneration in nonsmokers may reach 95%, whereas 65% in smokers. Currently, lifetime tobacco smoking has been associated with deterioration in bone quality.

Research Methodology

The studies related to the smoking effects on dental implant success. This review co-relates the studies done on effect of smoking on peri-implant tissues and its effect on success of implant. Relevant clinical studies written in English between

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Effects Of Smoking 2015

1990 and 2012 were reviewed. Articles were searched through EBSCO and manually through the references of the peer reviewed literature.

Bain and Moy were the first to evaluate the influence of smoking on the failure rate of dental implant. They compared the results between smokers and nonsmokers patients in which implants were placed. He found that overall failure rate of 5.92% and specifically implant failure in smokers was 11.28% as compared to 4.76% in nonsmokers.

Bain did a prospective study which constituted 223 consecutive branemark implant placed in 78 patients. Patients were divided into three groups: Nonsmokers (NS), smokers cessation protocol (SQ), and smokers who continued smoking (SNQ). He found that there was statistically significant difference between failure rate in NS and SNQ group (P < 0.005) and between SQ and SNQ group (P < 0.5), but none between NS and SQ groups.

In their study compared incidence of complication and survival rate related to dental implants between smokers and nonsmokers by analyzing data of 959 implants placed in 261 patients between 1995 and 1998. He subdivided patients into non-smokers, mild smokers (up to 10/day), and heavy smokers (>10/day), smokers were further subdivided according to duration in two groups <10 years and >10 years. In their study they found,

tested a hypothesis that interrupted cigarette smoke inhalation would reverse the bone quality around implant and found that smoking may affect bone quality in cancellous bone and smoke cessation could result in a return toward the level of control group.

Compared marginal bone loss (MBL), survival, and radiographic evidence of success of dental implants between smokers and nonsmokers. The study demonstrated a relationship between MBL and smoking habits. A higher incidence of MBL was found in the smoking group, and this was more pronounced in the maxilla.

Evaluated effect of smoking on the supporting alveolar bone and its cessation effect. Total 60 male rats were taken and divided into groups.

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Effects Of Smoking 2015

Five months after the beginning of cigarette smoke inhalation regime (2 months for group 2), the animals were killed and the mandible was removed and prepared for histological sections. The proportion of mineralized tissue in the furcating area (i.e., a 1,000 micrometer Zone under the furcating and between the roots) was obtained.

Data analysis demonstrated that the animals continuously exposed to cigarette smoke inhalation presented a decreased proportion of mineralized tissue (groups 2 and 4), when compared to control and cessation groups (groups 1 and 3) (P < 0.05). Similar levels of proportion of mineralized tissue were observed in groups 1 and 3, showing a beneficial effect of cigarette smoke inhalation cessation on proportion of mineralized tissue.

in a long-term retrospective study evaluated, the survival of bran mark end osseous dental implants in relation to cigarette smoking. The sample consisted of 464 consecutively treated completely and partially edentulous patients who had a total of 1,852 implants placed between 1979 and 1999, and who was part of a surgical/ prosthodontic prospective treatment outcomes study. The effect of cigarette smoking on implant survival in relation to the time of implant failure, gender, age, surgeon, date, and site of implant placement, implant length and diameter, prosthesis design, and occlusal loading.

Interpretation of Results

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Effects Of Smoking 2015

conducted a case controlled study with 5-year follow-up study consisted 226 patients, 113 consecutive patients with immediately provisional zed dental implant (cases) and 113 randomly selected controls with conventional late implant loading. In their study, they reported 20.8% patients having habit of smoking. Average time of smoking was 23.8 ± 10.9 years and average amount of cigarettes per day was 16.5 ± 8.9. They found that there is no significance difference found between case and control regarding habit of smoking.

They concluded that smoking cessation protocol described shows considerable promise in improving success rate or osseointegration in smokers who follow it.

the success rate of unilateral maxillary fixed dental prosthesis (FDPs) on implants in patients at a periodontal clinic referred for periodontal treatment, (2) the prevalence of varying mechanical and biological complications, and (3) effects of potential risk factors on the success rate. They analyzed that smokers had significantly fewer teeth, more periodontal pockets >4 mm and a tendency toward greater marginal bone loss at the follow-up, compared with nonsmokers.

Assessed and compared the peripheral blood neutrophil chemo taxis in smokers and nonsmokers with healthy periodontium, gingivitis, and chronic periodontitis. A total of 60 smokers and 60 nonsmokers were examined for this study. Both the groups included 20 subjects with gingivitis, periodontitis, and healthy periodontium. The periodontal status of the study subjects was assessed by gingival index, Russell’s periodontal index, sulcus bleeding index, and clinical attachment level. The blood sample was taken from each individual for the chemo tactic analysis using agarose method. In this study, there was a significant decrease in the neutrophil chemotaxis in smokers with gingivitis, periodontitis, and healthy periodontium, compared to nonsmokers with similar findings.

In their retrospective study determined the effect of cigarette smoking and residual native bone height on the survival of dental implant, placed in immediately in grafted sinus. Total 334 subjects were screened in which 75 subjects were selected and 155 implants were placed. They subdivided subjects into smokers and nonsmokers, in which they found:

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Effects Of Smoking 2015

In their studies, they also related implant success rate with bone height among smokers and non smokers and analyzed that effect of smoking was significant when preoperative length of bone height is less than 4 mm.

Conclusion

There is significant difference in the failure rates of dental implants between smokers and nonsmokers and smokers are at twice risk of implant failure compared to that in nonsmokers and effect maxillary implant more compared to mandible implants.

Smoking has a significant effect on dental implants placed in patient having bone height less than 4 mm.

Effect of smoking get worse with increased amount and duration of smoking per day.

Effect of smoking on the dental implant can be reversed if patient follow smoking cessation protocols.

References

1. Lin TH, Chen L, Cha J, Jeffcoat M, Kao DW, Nevins M, et al. The effect of cigarette smoking and native bone height on dental implants placed immediately in sinuses grafted by hydraulic condensation. Int J Periodontics Restorative Dent 2012;32:255-61. Back to cited text no. 1

2. Palma-Carrió C, Maestre-Ferrín L, Peñarrocha-Oltra D, Peñarrocha-Diago MA, Peñarrocha-Diago M. Risk factors associated with early failure of dental implants. A literature review. Med Oral Patol Oral Cir Bucal 2011;16:e514-7. Back to cited text no. 2

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Effects Of Smoking 2015

3. Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. Int J Oral maxillofacial Implants 1993;8:609-15. Back to cited text no. 3

4. Balshe AA, Eckert SE, Koka S, Assad DA, Weaver AL. The effects of smoking on the survival of smooth- and rough-surface dental implants. Int J Oral Maxillofacial Implants 2008;23:1117-22. Back to cited text no. 4

5. Kronström M, Svenson B, Hellman M, Persson GR. Early implant failures in patients treated with Brånemark System titanium dental implants: A retrospective study. Int J Oral Maxillofac Implants 2001;16:201-7. Back to cited text no. 5

6. Van Steenberghe D, Jacobs R, Desnyder M, Maffei G, Quirynen M. The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage. Clin Oral Implants Res 2002;13:617-22. Back to cited text no. 6

7. Noguerol B, Muñoz R, Mesa F, de Dios Luna J, O'Valle F. Early implant failure. Prognostic capacity of Periotest: Retrospective study of a large sample. Clin Oral Implants Res. 2006;17:459-64. Back to cited text no. 7

8. Alsaadi G, Quirynen M, Komárek A, Van Steenberghe D. Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection. J Clin Periodontol 2007;34:610-7. Back to cited text no. 8

9. Alsaadi G, Quirynen M, Michiles K, Teughels W, Komárek A, Van Steenberghe D. Impact of local and systemic factors on the incidence of failures up to abutment connection with modified surface oral implants. J Clin Periodontol 2008;35:51-7. Back to cited text no. 9

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Effects Of Smoking 2015

10. Bornstein MM, Halbritter S, Harnisch H, Weber HP, Buser D. A retrospective analysis of patients referred for implant placement to a specialty clinic: Indications, surgical procedures, and early failures. Int J Oral Maxillofac Implants 2008;23:1109-16.

Bibliography

http://www.jdionline.org/article.asp?issn=0974-6781;year=2013;volume=3;issue=1;spage=46;epage=51;aulast=Goutam.

Submitted by Muhammad Zakaria

SP14-EX-0047

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