Dental implants Singapore- the impact of smoking on success

The cigarette industry amazes me. The health risks associated with smoking is well known but yet the sheer number of smokers in society is astounding. More than 4 million people die each year due to nicotine related illnesses such as heart attacks and stroke. Its impact on oral health is also well documented, increasing the risk of gum disease, root decay, oral cancer, staining of teeth and delayed wound healing. Oral surgical treatment such as dental implants may be affected adversely by it. As such, smokers have a higher risk of implant failure compared with non-smokers. Can smokers have dental implants, or are they destined to cope with dentures?

The way by which smoking affects wound healing in not fully understood. It may be due to the toxicity of the nicotine, the carbon monoxide decreasing oxygenation of the cells, constriction of the blood vessels, etc. All these factors lead to poorer response to gum treatment and higher incidence of dry socket after a dental extraction. For a host healing dependent treatment like dental implants, complication and failure rates are also higher compared with non-smokers. Studies have rates failure rates of implants for smokers at 6.5%-20% compared with the 2% of non-smokers. The constriction of the blood vessels caused by nicotine causes the slower healing. Nicotine also causes the white blood cells to be less effective in combating infection.

Dental implants in the upper jaw are also more prone to complications than those in the lower jaw. This may be due to the lower density bone in the upper jaw which may render it more susceptible to the effects of tobacco.

The impact of nicotine on implant success is also proportional to the concentration of nicotine in the blood. Heavy smokers are generally at poorer risk than light smokers. It is interesting to note though that smoking does not affect the initial bonding of bone to the implant surface. Instead, the failures increased after the exposure of the implant through the gum. The theory behind this is that the gum around the implant is more adversely affected by nicotine than the bone and the inflammation/infection starts at the level of the gum and then progress into the bone.

Typically, these complications occur within the first year of implant placement and then gradually decline over the next five years. Overall, the incidence of failure in smokers has been reported to be double that of non-smokers.

However, all is not lost for the smokers. Smokers who quit have a higher success rate than those who are still smokers. As such, quitting smoking will bring an ex-smokers implant success rate to a higher level. There are several recommended protocols to increase implant survival in smokers. For example, one protocol suggested stopping smoking one week before the implant surgery and maintaining it for another two months. However, all my smoker patients tell me that if they can stop for two months, they can stop forever. Some long time smokers did actually give up smoking completely because they wanted to have dental implants. It is just that there was no real tangible reason to stop previously and hence the determination was not great.