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Title Tobacco Smoking Negatively Affects Implant Survival
Clinical Question In an otherwise healthy adult, does smoking tobacco increase the risk of intraosseous dental implant failure?
Clinical Bottom Line Smoking tobacco does increase the risk for intraosseous implant failure, due primarily to exposure of the peri-implant tissue to tobacco smoke. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16907781Hinode/200619 different studies patientsMeta-Analysis
Key resultsThe odds ratio for osseointegrated implant failure in smoking patients was elevated compared to nonsmokers. (OR 2.17 Confidence Interval 95%)
#2) 11885185Lambert/2000800 adults at 32 different centersRetrospective Cohort Study
Key resultsOver the three-year period failures were “significantly” higher for smokers than non-smokers".
#3) 17509093Strietzel/2007Articles must have included odds ratios, hazard ratios, or risk ratios among smokers who had failed implants, or reports of complications which affected implant successSystematic review and meta-analysis
Key resultsMeta-analysis revealed a significantly enhanced risk for implant failure among smokers: [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). Systematic review showed higher risk of complications associated with smoking groups, however, five studies in which particle blasted, acid etched or anodic oxidized surface implants were used there was no significant difference between groups.
Evidence Search Meta-Analysis, Randomized Controlled TrialSearch Limits: Meta-Analysis, Randomized Controlled TrialSearch, Search smoking [Mesh] Search dental implants [Mesh]
Comments on
The Evidence
The groups in the Lambert study were similar at the start of the study, separated into smokers and non-smokers. There was adequate compliance and there was no recall bias or competing interests evident. The Hinode and Strietzel papers were systematic reviews with Meta-Analysis
Applicability The results from these articles are highly suggestive of the influence smoking has on implant failure and apply significantly to patients considering implants whom smoke tobacco.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Dental Hygiene) (Behavioral Science)
Keywords Smoking, Implant, Tobacco, Prognosis
ID# 563
Date of submission: 04/14/2010spacer Revised: 09/19/2011
E-mail allisonr@livemail.uthscsa.edu
Author Ryan Allison
Co-author(s) Joshua R. Chapa
Co-author(s) e-mail
Faculty mentor/Co-author Kenneth Kalkwarf, DDS, MS
Faculty mentor/Co-author e-mail KALKWARF@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Matt Checketts (San Antonio, TX) on 07/12/2011
I have repeated a search on PubMed to validate these findings. The conclusions reached in this analysis are still current and correct.

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