Article

The effect of smoking on osseointegrated dental implants. Part I: Implant survival

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Recent studies implicate smoking as a significant factor in the failure of dental implants. The purpose of this long-term retrospective study was to evaluate the survival of Brånemark endosseous dental implants in relation to cigarette smoking. The sample consisted of 464 consecutively treated completely and partially edentulous patients who had a total of 1852 implants placed between 1979 and 1999, and who were 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 considerations was assessed in bivariate and multivariate survival analyses. The overall implant failure rate was 7.72%. Patients who were smokers at the time of implant surgery had a significantly higher implant failure rate (23.08%) than nonsmokers (13.33%). Multivariate survival analysis showed early implant failure to be significantly associated with smoking at the time of stage 1 surgery and late implant failure to be significantly associated with a positive smoking history. Short implants and implant placement in the maxilla were additional independent risk factors for implant failure. Cigarette smoking should not be an absolute contraindication for implant therapy; however, patients should be informed that they are at a slightly greater risk of implant failure if they smoke during the initial healing phase following implant insertion or if they have a significant smoking history.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Almost all studies considered treatment-related factors in their risk analyses on early implant loss. A number of studies identified implants placed in the maxilla, 24,75 or in the posterior region of the maxilla in particular, 59,68,80 to be at higher risk. Interestingly, the study with the largest cohort reported the highest risk for early loss for implants placed in the anterior region of the mandible. ...
... Only a minority of the identified papers studied the effect of experience or training of dental professionals on late implant loss and these analyses were limited to the surgical part of the therapy, 75,89,95 while only one report considered the level of clinical expertise with respect to prosthetic treatment and during supportive care. 5 None of the investigations identified any statistically significant association with late implant loss. ...
... 50,82 Studies were in general agreement that implant diameter was not associated with late implant loss. 5,32,34,43,52,75,95 In summary, to date, no risk indicators for late implant loss have been consistently and clearly identified. ...
Article
Full-text available
Implant therapy aims at providing the patient with a functional and esthetically pleasing rehabilitation in a long‐term perspective. The loss of an implant constitutes a major complication, which may have an impact on the treatment plan and/or jeopardize the longevity of the restoration. Implant loss may occur during the phase of osseointegration (early) or at a later time when the previously achieved osseointegration is lost (late). The present work evaluates the evidence on the occurrence of both events and discusses etiology, risk factors, and consequences.
... This condition leads to epithelial down-growth, the so-called saucerization or marsupialization of the implant, and eventually results in mobility or loss of the implant fixture. Some studies have identified age, fixture length, smoking, location of the implant, and/or bone quality as factors influencing early implant failure [9][10][11]. ...
... Late failure is defined as occurring after occlusal loading of the implant fixture and has been associated with periimplantitis as a result of plaque-induced alveolar bone resorption and/or non-axial occlusal overloading forces [12]. The risk factors for late failure have been reported to be age, smoking, fixture length, and/or the location of the implant [9,13]. There has been, however, some controversy about fixture length relating to the reliability of short implants. ...
... The incidence of early and late implant failure in smokers was 2.4 and 3.0 times higher than in non-smokers, respectively. Several studies have also demonstrated that a smoking habit reduced the success rate of osseointegration [9,11,28,29]. ...
Article
Many studies have identified risk factors for dental implant failure, although few have investigated the correlation among implant fixtures within single patients. A better analytical method may include repeated measures analysis including generalized estimating equations (GEE). This retrospective cohort study aimed to (1) identify the risk factors for failure of dental implantation and (2) evaluate an analytical method using GEE analysis. We analyzed data on early and late implant failures in 296 patients providing 721 rough surface dental implants (2.44 implants per patient). Potential predictors of implant failure included age, gender, smoking, location of implant, use of bone augmentation, number of remaining teeth, opposing tooth condition, fixture length, fixture diameter and type of suprastructure (fixed or removable partial denture). The likelihood of early and late implant failure was estimated by GEE. The early failure rate was 1.5% (11/721 implants, 7/296 patients) and the 10-year cumulative survival rate was 94.0% (7/710 implants, 5/293 patients). The GEE analysis revealed that a significant risk factor for early implant failure was smoking (p<0.01), whereas significant risk factors for late failure were maxillary implant (p=0.02), posterior implant (p<0.01), number of remaining teeth (≥20) (p<0.01), opposing unit being a removable partial denture or nothing (p=0.04) and having a removable type suprastructure (p<0.01). GEE analysis showed that smoking was a risk factor for early implant failure, and several risk factors were identified for late implant failure. Copyright © 2015 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
... Deluca et al. 19 (2006) avaliaram a taxa de sobrevida de implantes dentais em 464 pacientes ao longo de 10 anos. A Taxa global de falha dos implantes foi de 7,72%. ...
... A Taxa global de falha dos implantes foi de 7,72%. Os pacientes fumantes e que receberam implantes tiveram alta taxa de falha de osseointegração (23,08%,) quando comparados aos pacientes não fumantes (13.33%), relatando que o cigarro é um fator de risco no aumento de falhas nos implantes 19 . ...
... Entretanto, o tabaco não pode ser considerado contraindicação absoluta para a reabilitação com implantes dentais, ainda que haja maior tendência ao risco de perda precoce de implantes dentais, o que deve ser informado e bem esclarecido ao paciente tabagista, principalmente sobre uso do cigarro no período inicial do reparo tecidual. Além disso, independente da cessão do ato de fumar, imediatamente, antes da cirurgia de instalação dos implantes, aqueles que fazem uso do cigarro por longos períodos apresentam maior índice de perda óssea marginal tardia 19 . ...
Article
O fumo é um forte indicador de risco para implantes osseointegrados e os insucessos estão relacionados com as fases envolvidas durante o processo de reparo e Osseointegração, além da sobrevida dos implantes em decorrência do aumento da incidência de peri-implantite e mucosite peri-implantar, e como consequência em alguns casos a perda do implante. A nicotina representa a substância de maior expressão e toxicidade nos cigarros sobre os tecidos da cavidade oral. Assim, o presente estudo tem por objetivo revisar a literatura associando a influência e o risco do tabagismo à importância da saúde peri-implantar para previsibilidade do tratamento. Há estudos que também concluíram que o fumo aumenta o risco de peri-implantite e perda óssea peri-implantar. Assim, podemos concluir que o tabaco influencia negativamente na osseointegração e sobrevida dos implantes de titânio, devido aos efeitos citotóxicos das suas substâncias
... Dans leur étude portant sur 540 patients ayant reçu 2 194 implants, le taux global d'échec implantaire était de 5,92 %, variant de 11,2 % chez les fumeurs à 4,7 % chez les non-fumeurs (p < 0,001). Depuis, de nombreuses études ont retrouvé des taux d'échec implantaire plus importants chez les fumeurs que chez les non-fumeurs [178][179][180][181][182][183][184][185][186][187][188]. ...
... Plusieurs études retrouvent ce taux d'échec implantaire à long terme (entre 18 mois et 10 ans) plus élevé chez les fumeurs que chez les non-fumeurs [180][181][182][183][184][185][186][187][188][189][190][191][192]. Toutefois, quelques études n'ont pas retrouvé de différence significative du taux d'échec implantaire entre fumeurs et non-fumeurs [193][194][195]. ...
Article
Full-text available
Effects of smoking on periodontal disease Smoking is an independent risk factor for periodontal disease and tooth loss. Smoking impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Periodontal disease is increased both in prevalence and severity in smokers. Smoking is a predisposing factor to acute necrotizing ulcerative gingivitis and is associated with an increased rate of periodontal disease in terms of pocket formation and attachment loss, as well as alveolar bone loss. Cigar, pipe, water-pipe and cannabis smoking have similar adverse effects on periodontal health as cigarette smoking. Passive smoking is also an independent periodontal disease risk factor. Smokeless tobacco is associated with localized periodontal disease. Smokers respond less favourably to both non-surgical and surgical treatments and have higher failure rates and complications following dental implantation. Smoking cessation may halt the disease progression and improve the outcome of periodontal treatment. Smoking cessation counselling should be an integral part of periodontal therapy and prevention.
... There is still no sufficient data with regard to immediate dental implants placed in infected sites [9][10][11] . Several factors like heavy smoking can influence the process and/or maintenance of osseointegration leading to implant failure [12][13][14] . Peri-implant inflammations affecting the soft and hard tissue around the implant usually remain limited locally. ...
... At the time of implant placement, the patient was a heavy smoker. Smoking is a significant risk factor for both the process and maintenance of osseointegration of dental implants and is associated with increased implant failure rates [12][13][14] . Besides the negative impact on general factors of the oral environment like the depression of the immune system 18 , smoking represents an important risk factor in the pathogenesis of osteomyelitis 17 . ...
Article
Purpose: To report a rare and dramatic complication following immediate dental implant placement in a heavy smoker, who had a delayed diagnosis of uncontrolled diabetes. Materials and methods: In this case report we present the dramatic course of a 64-year old female patient treated with five immediate post-extractive dental implants in the mandible, who developed osteomyelitis, which manifested initially as local peri-implant inflammation and progressed into a spontaneous jaw fracture, despite repeated surgical interventions and antibiotic courses over a 3-year period, until diabetes was diagnosed. Results: A symptom-free status could be achieved only after partial mandibulectomy, treatment of diabetes and reconstruction with a microvascular fibula free flap. Conclusion: In the presence of mandibular osteomyelitis refractory to therapy, yet undiagnosed underlying pathologies, such as diabetes, should be investigated and treated urgently.
... This condition leads to so-called saucerization or marsupialization of the implant and eventually results in mobility and implant loss. Some studies have identified age, fixture length, smoking, implant location, and/or bone quality as factors influencing early implant failure DeLuca et al., 2006;Mesa et al., 2008). Late failures have been defined as occurring after prosthetic rehabilitation Noda et al., 2015). ...
... The negative impact of tobacco on implants installed in graft areas was also reported in a systematic review conducted by Chambrone et al. (2014). Several studies have also demonstrated that a smoking habit reduces the success rate of osseointegration (Kan et al., 2002;van Steenberghe et al., 2002;DeLuca et al., 2006;Clementini et al., 2014;Moraschini and Porto Barboza, 2016). A regular and strict recall of smokers undergoing implant treatment is therefore quite recommendable for early detection of implant complications (Aglietta et al., 2001). ...
Article
Full-text available
Aim The aim of this study has been to identify risk factors for post-operative complications after grafting bone from different donor sites prior to implant placement. Material and methods The study encompassed 279 patients who underwent autologous bone augmentations in a 2-stage procedure, harvested from three intraoral and one extraoral donor sites, as well as sinus floor elevations prior to implant placement. The following complications were recorded: soft tissue dehiscence; wound infection; bone graft exposure; sensory disturbance; sinusitis symptoms; haemorrhage; graft failure; implant failure. Complications were correlated with: patient age; smoking status; history of gingivitis/periodontitis; cause of tooth loss; jaw area; dental situation; sinus membrane perforation; surgeons' experience. Results 279 patients underwent 456 augmentation procedures, involving 546 sites. 436 grafts were successful. 525 implants were inserted into 436 augmented sites in 273 patients. 20 grafts were lost due to complications. 2 implants were removed before prosthetic restoration. 2 implants were lost within 2 years after placement. Age (p = 0.0009, Odds Ratio = 2.44), smoking (p < 0.0001, Odds Ratio = 2.47), Approximal Plaque Index (p < 0.0001, Odds Ratio = 6.64), Sulcus Bleeding Index (p < 0.0001, Odds Ratio = 39.06) and dental situation (p < 0.0001) were significantly correlated with higher post-operative morbidity. Cause of tooth loss (p = 0.7399), jaw area (p = 0.6725), sinus membrane perforation (p = 0.0762) and surgeons' experience (p = 0.0939) did not influence complication rates. Conclusions Patients over 40 years old, smokers, a history of periodontitis, and augmentation in tooth gaps involving more than one tooth represent a significantly increased risk of there being post-operative complications compared with patients younger than 40 years old, non-smokers, no history of periodontitis, only a single-tooth gap, or free-end arch situations.
... 14,15 Consistent with this hypothesis, studies have demonstrated that smoking and periodontitis predict implant failures. 16,17 Poorly controlled diabetes mellitus (DM) adversely affects oral wound healing and would thereby be expected to increase the risk of early implant failures and periimplantitis. 18 Different treatment-related factors have been associated with an increase in implant failures. ...
... 19,20 Studies have shown that early failures occurred predominantly in the posterior maxilla. 17,19,21 Increased early failure of implants was observed for narrow-diameter implants. 22,23 Largerdiameter implants have been also associated with early implant failures. ...
Article
Full-text available
Statement of problem: Despite an overall high survival rate for dental implants, the effectiveness of implant retreatment remains unclear. Purpose: The purpose of this systematic review was to examine the survival rate of implants placed at sites which had an implant failure and to investigate factors that might affect outcomes after retreatment. Material and methods: A search of electronic databases limited to English language articles was conducted using the following MeSH terms: "dental implants," "dental implantation," or "dental restoration failure," combined with "retreatment," "replacement," or "reoperation." A hand search of selected journals was also performed. Of the retrieved 668 publications, 8 retrospective clinical studies met the inclusion criteria, providing the survival outcome for 673 implants in 557 patients after retreatment. Implant- and patient-related characteristics related to implant failures were assessed. Results: The weighted mean survival rate for implants after retreatment was 86.3%, with follow-up ranging from less than 1 year to over 5 years. The survival rates of smooth-surfaced and rough-surfaced implants were compared in 217 retreated implants, revealing a significantly higher survival rate for rough-surfaced implants than for smooth-surfaced implants (90% versus 68.7%). Insufficient data were available to evaluate the effect of patient- or treatment-related characteristics on the survival of implants after retreatment. Conclusions: The survival rate of retreated implants is lower than that generally reported after initial implant placement. Higher survival rates were reported with rough-surfaced implants than with smooth-surfaced implants in retreatment. An overall implant survival rate of 86.3% after retreatment suggests that most initial implant failures are likely attributable to modifiable risk factors, such as implant architecture, anatomic site, infection, and occlusal overload.
... Cigarette smoking was previously reported to have a detrimental effect on early bone tissue response around dental implants, with marginal bone loss, gaps, and fibrous tissue surrounding the implants retrieved from smokers, together with a significant decrease in bone to implant contact percentage compared to nonsmokers (2). Furthermore, smoking is considered by several publications to be a risk factor for the success of dental implants (3)(4)(5)(6)(7) irrespective of the loading regimen (delayed or immediate loading) (3). A 5-year pragmatic multicenter retrospective cohort study of 1,178 nonsmokers and 549 smokers investigating the influence of cigarette smoking on the survival of dental implants registered significantly more implant failures in smokers compared to nonsmokers when all implant failures within 5 years of loading were taken into account (5). ...
... Cigarette smoking was previously reported to have a detrimental effect on early bone tissue response around dental implants, with marginal bone loss, gaps, and fibrous tissue surrounding the implants retrieved from smokers, together with a significant decrease in bone to implant contact percentage compared to nonsmokers (2). Furthermore, smoking is considered by several publications to be a risk factor for the success of dental implants (3)(4)(5)(6)(7) irrespective of the loading regimen (delayed or immediate loading) (3). A 5-year pragmatic multicenter retrospective cohort study of 1,178 nonsmokers and 549 smokers investigating the influence of cigarette smoking on the survival of dental implants registered significantly more implant failures in smokers compared to nonsmokers when all implant failures within 5 years of loading were taken into account (5). ...
Article
Full-text available
The aim of this study was to compare the 5-year outcome of full-arch mandibular fixed prosthetic rehabilitation using the All-on-4 concept in smoking and nonsmoking patients. This retrospective cohort study included 200 patients (n = 100 smokers, n = 100 nonsmokers), 119 women and 81 men, with an average age of 53.7 years, rehabilitated in immediate function with 800 implants. Implant cumulative survival rate estimation (Kaplan-Meier with log-rank test) and marginal bone resorption (MBR) at 5 years (Mann-Whitney test) were compared between both groups. Multivariable analysis was used to investigate potential risk indicators for MBR ≥ 2.8 mm at 5 years. Nine patients (4.5%) were lost to follow-up. Four patients lost eight implants, specifically one nonsmoking patient (n = 1 implant) and three smoking patients (n = 7 implants), resulting in a cumulative survival rate estimation of 99.0% and 96.9% for nonsmokers and smokers, respectively (P = 0.296). The average (standard deviation) MBR at 5 years was 1.68 mm (0.76 mm) and 1.98 mm (1.02 mm) for nonsmokers and smokers, respectively (P = 0.045). Smoking (odds ratio = 2.92) was the only risk indicator significantly associated with MBR ≥ 2.8 mm in multivariable analysis. Smoking should not be an absolute contraindication for rehabilitation of the edentulous mandible through the All-on-4 concept; however, smoking habits were significantly associated with MBR ≥ 2.8 mm.
... Smoking and systemic diseases such as uncontrolled diabetes mellitus (DM) and periodontitis are characterized as patient-related risk factors for implant failure (Bain & Moy 1993;De Luca, Habsha, Zarb, 2006;Jemt & Hager 2006;Chrcanovic, et al., 2014). Therapeutic options after implant failure are a controversial topic of discussion. ...
... Smoking and endocrine diseases are patient-related risk factors for first implants. These factors might also affect the survival of re-treated implants (Bain & Moy 1993;De Luca, et al., 2006;Jemt & Hager 2006). However, a recently published review concluded that DM and smoking did not negatively affect implant outcomes (Agari & Le 2020). ...
Article
Full-text available
Objectives: To compare the long-term survival of dental implants placed in patients with and without a history of implant failure. Material and methods: Within a retrospective analysis, an experimental group was selected consisting of 59 patients with 137 implants placed after previous failure. The control group included 1072 patients with 2664 implants without previous failure. Kaplan-Meier curves were used to describe the group-specific long-term implant survival. Mixed-effects Cox regression models were applied to examine the effects of patient- and site-specific risk factors. To take multiple implants into account, a random intercept model was applied. Results: During the observation period of up to 15 years, 11 implants (8%) failed in the experimental group and 74 implants (2.5%) in the control group (p < 0.001). Five-year cumulative survival was 96.8% (95% CI 0.96-0.98) in the control group and 91.5% (95% CI 0.86-0.97) in the experimental group. The variables group assignment and simultaneous augmentation had a significant effect on survival but this effect was lost in the random intercept model. The effect of implant location remained, whereby the risk of failure was five times lower for mandible implants, irrespective of group (p = 0.013; 95% CI 0.103-0.767; HR: 0.281). Conclusions: Long-term implant survival was lower in the experimental group than in the control group. The effect of previous failure was negligible. However, a patient-specific "clustering-effect" was observed. Irrespective of previous implant failure, the risk of long-term failure is two times higher for maxillary implants than for mandibular implants.
... İmplantın etrafındaki dokularının sigara dumanına lokal olarak ekspoze olması implant başarısızlık oranının genel olarak artmasına yol açan temel faktör olduğu kuvvetle önerilmiştir. DeLuca ve arkadaşları, 10 yıllık takip çalışmasından dental implantla rehabilite edilen hastalarda sigara içenlerde sigara içmeyenlere göre daha yüksek başarısızlık oranı saptamışlardır (12). ...
Article
Abstract: In this clinical trial, investigated the effect of smoking on marginal bone loss, plaque index, gingival index and bleeding on probing on dental implants. For this retrospective study, participants were selected from patients who had been rehabilated with implant supported fixed prosthesis at Eskişehir Osmangazi University Dental Faculty between February 2013 and January 2018. Various information about age, gender and smoking habits were recorded for each patient. Marginal bone loss was measured on panoramic x-rays using corel draw 11.0 software. The study was conducted on a total of 118 patients who underwent a total of 312 implants at 6, 12 and 24 months of age. The ages of the patients ranged from 24 to 70 years and the mean age was 47 ± 8.29. Patients included in the study, 50 were male and 68 were female, 98 were non-smoking and 20 were smoking. In this study, the effect of smoking on marginal bone loss in distal region was statistically significant gingival index in smokers, bleeding in the probe and plaque index showed statistically significant differences with period. Patient sex and age; it can be deduced that there is no effect on marginal bone loss, but in those with smoking habits the surround of the implant is more involved with plaque involvement and bleeding in the probing than non-smokers, the risk of implant crestal bone loss increases with smoking habit and may lead to implant loss.
... Early implant failure was significantly associated with smoking at the time of stage 1 surgery and late implant failure correlated with a positive smoking history in the multivariate analysis. The study concluded that smoking is not an absolute contraindication, however, could impair the initial healing phases (32). Within the limitations of our review, it is safe to suggest that predisposing factors like smoking, alcohol, and poor oral hygiene are responsible for the lower osseointegration rates in irradiated sites. ...
Article
Full-text available
Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in nonradiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients
... Patients with severe occlusal parafunctions and temporomandibular disorders according to the system of research diagnostic criteria for temporomandibular disorders (RDC/TMD) were not included [21][22][23]. Only nonsmoking patients were included in this case series [24][25][26]. Further inclusion criteria for patients receiving implant therapy were two missing posterior teeth, sufficient bone for an implant 3.8 mm in diameter and 11 mm in length (minimum implant dimension according to the manufacturer) in the mandible, no contraindication for dental implants, good general health condition and no contraindication for sinus augmentation (if necessary). ...
Article
Full-text available
Objectives: This case series compared the clinical survival of tooth-implant-supported (TI-S) and tooth-supported (T-S) three-unit fixed dental prostheses (FDPs) with zirconia frameworks and described the incidence of biological and technical complications. Materials and methods: Forty-four patients received 27 TI-S FDPs and 22 T-S FDPs. Twenty-seven titanium screw implants were inserted at the dislodged position of two missing posterior teeth. All implants were provided with customized zirconia abutments. Zirconia frameworks were fabricated by a CAD/CAM system and veneered in powder build-up technique. All restorations were cemented with glass ionomer. Baseline evaluation was performed 2 weeks after cementation with recall examinations performed at 6, 12, 24 and 36 months by calibrated investigators. Survival probabilities according to Kaplan-Meier were calculated. Gingival parameters and bone loss were assessed and statistically evaluated. Results: The mean service time of the FDPs was 35 months (±6). Two technical complications (fracture of veneering porcelain) were observed. One biological complication was recorded. The Kaplan-Meier survival probability was 93.9 % for all types of complications and 100 % related to restorations in service. The type of abutment support (TI-S vs. T-S) had no significant influence on the survival probability (p = 0.412, log rank test). No difference of the gingival parameters was detected between implants and natural teeth. Conclusions: Tooth-implant-supported zirconia-based FDPs showed similar clinical performance compared to tooth-supported zirconia-based FDPs. Clinical relevance: Within the limitations of this case series, tooth-implant-supported FDPs with zirconia frameworks seem to be a reliable treatment option.
... The use of antibiotic protection is justified when the procedure duration was prolonged or at the same time several implant were embedded or the surgeon faced difficult conditions [21]. Success of the procedure also depends on education and awareness of the patient who should care for oral hygiene as well as on whether they reduce using stimulants such as cigarettes and alcohol [22,23]. Implementation of prophylactic antibiotic therapy in a surgical procedure in our practice produced improved efficacy of implantation regardless of the patient's conditions and habits. ...
Article
Full-text available
Purpose: The use of antibiotic therapy during implantation to reduce the risk of an early implant failure is widely discussed among clinicists. However, half an hour after the procedure a quarter of patients show bacteremia which could decrease the efficacy of the surgery. Implant failure is associated with destruction of bone tissue within the alveolar process and may lead to an alternative but compromised treatment plan. The aim of the study was to evaluate the influence of perioperative antibiotic protection on success of implantation. Material and methods: The retrospective study involved 1915 patients (females: 57.3%, males: 42.7%) with no systemic or local diseases, who required antibiotic therapy during surgical procedures. Group 1 comprised 203 patients with diagnosed vertical or horizontal bone atrophy within the alveolar ridge requiring reconstruction procedure before implantation. Group 2 included 1712 patients who did not need any surgical procedures before implantation. All the subjects took three types of antibiotics twice a day for 7 days. The data were statistically analyzed. Results: A total number of 3309 implants were placed. Implantation efficacy in group 1 amounted to 98.53% and in group 2 it was 99.24%. Complications occurred most commonly after administration of cephalosporin which proved to be statistically significant for the patients who underwent augmentation with a bone block before the implant procedure (p 0.0209). Conclusions: Perioperative use of antibiotic therapy beneficially influences tissue healing, provides safety and success of the surgical procedure, as well as translates into high efficacy of implantation (99.52%).
... Early implant failure was significantly associated with smoking at the time of stage 1 surgery and late implant failure correlated with a positive smoking history in the multivariate analysis. The study concluded that smoking is not an absolute contraindication, however, could impair the initial healing phases (32). Within the limitations of our review, it is safe to suggest that predisposing factors like smoking, alcohol, and poor oral hygiene are responsible for the lower osseointegration rates in irradiated sites. ...
Preprint
Head and neck cancer" is a term used to describe several different malignant tumours that develop in or around the throat, larynx, nose, sinuses, and mouth. These account for 4% of all the cancers Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in non-radiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients.
... The present study also found that smoking increased the risk of implant failure (OR = 3.23), which corresponds to the results of Busenlechner et al (OR=3)29 and several other studies. [34][35] The failure rate of 2.8% was low and was in accordance with Berglundh et al's28 systematic review, which found an overall implant failure rate of 2% to 5% af ter 5 years. The implant-related risk factor analysis in the study population of the present study (length and diameter) failed to show any adverse effect on the im plant survival, which is similar to the findings reported by systematic reviews.36-37 ...
Article
Full-text available
Purpose: The purpose of this study was to evaluate the clinical, radiographic, and patient-based outcomes of dental implants placed at an undergraduate student dental clinic. Materials and methods: A retrospective study was performed to determine the success and survival rates of dental implants placed at the undergraduate dental clinic at Dalhousie University between January 1999 and January 2012. Only patients with a minimum of 1-year follow-up were included. Clinical and radiographic assessments determined implant success and survival rates. Questionnaires recorded patients' satisfaction with esthetics, comfort, and ease of hygiene. Results: Of the 352 patients (n = 591 implants) who received implants over 13 years, 165 patients completed the clinical and radiographic examinations. By the end of the study period, demographic information and implant characteristics were collected for 111 (n = 217 implants; 47.5% in the maxilla, 52.6% in the mandible) of these patients. Of those assessed clinically, 36.4% were males and 63.6% females, with a mean age of 56.1 ± 14.15 years (range, 17 to 86 years) at the time of implant placement. The mean follow-up period was 5.8 years (range, 1 to 13 years). The overall implant success and survival rates were 88.0% and 97.2%, respectively. No observable bone loss was evident in 88.0% of the surviving implants. There were no implant fractures. Most patients (91.2%) were very satisfied with the implant restoration appearance, 88.0% were very comfortable with the implant, 92.6% were very satisfied with their ability to chew, and 84.8% reported easy hygiene maintenance at the implant sites. Conclusion: Implant success and survival in an undergraduate student clinic were comparable to those reported in the literature. It seems that inexperienced students were able to provide restorations that were very satisfying to the patients.
... This observation is in accordance with previous works showing that smokers have a higher risk of implant failure, peri-implantitis, and MBL than nonsmokers. [59][60][61][62] Also, most of the complications or failed implants occurred in smokers. 39,44,47,54,55 Therefore, smoking should also be considered as a risk factor for MBL when placing implants with computer guidance, yet there is insufficient evidence to draw robust conclusions. ...
Article
Full-text available
Purpose: The radiologic outcomes of implants placed using static computer-guided surgery have not yet been systematically investigated. The purpose of this study was to evaluate the marginal bone loss (MBL) around dental implants inserted with static computer assistance in healed sites. Materials and methods: An electronic search of publications in English from three databases (from 2000 to March 2015), including PubMed, Web of Science, and Cochrane Oral Health Group Trials Register, and a hand search of peerreviewed journals for relevant articles were performed. Only clinical human studies, either randomized or nonrandomized, with at least 10 cases and a minimum follow-up time of 12 months, reporting on MBL were included. Results: The search strategy resulted in 18 publications, with 2,675 implants inserted with static computer assistance in healed sites. The pooled mean MBL at 1-year follow-up was 1.06 mm (95% CI: 0.83 to 1.30 mm; heterogeneity: random-effects model, I² = 99.38%; P < .01). Moreover, when considering studies with a 3-year follow-up only (n = 5; 748 implants), the pooled MBL was 1.48 mm (95% CI: 0.81 to 2.15 mm; heterogeneity: random-effects model, I² = 99%; P < .01). Conclusion: Within the limitations of this review, the MBL around dental implants placed in healed sites with computer-guided surgery seems to be a well-functioning one-stage alternative to extended two-stage conventional procedures if patients are appropriately selected and an appropriate width of bone is available for implant placement. However, current evidence is limited by the quality of available studies and the lack of comparative long-term clinical trials.
... Studies have shown correlation between age, gender, insertion site, fixture length, smoking and success of an implant. [3][4] Late failures occur after occlusal loading of the implant and has been associated with plaque induced peri-implantitis. Since two-stage implant system are frequently used they result in a micro-gap at the implant-abutment junction, this hollow space provides a favourable site Access this article online Quick Response Code: ...
... Some studies have identified age, sex, comorbidities, smoking, type of edentulism, implant location, implant length and diameter, and bone quality and volume as factors influencing early implant failure. 6,[8][9][10] The aims of the present study were to identify the indications for implant placement, risk factors for early implant failure, and early success rate in a large group of consecutive patients treated in the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven over a 3-year period (2012 to 2014). ...
Article
Full-text available
Purpose: The aim of this study was to review the indications for implant placement, early outcomes, and associated risk factors. Materials and methods: A retrospective cohort study design was used. The study was composed of a group of 509 consecutive patients, which represented the total number of patients treated from 2012 to 2014 in the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium. The authors analyzed the indications for implant placement and the potential risk factors for early implant failure. Results: A total of 509 patients received 1,139 dental implants. The group consisted of 240 men and 269 women, with a median age of 58 years. The most frequent indication for implant placement was restoration of a partially edentulous arch (80.1%, n = 408). For 152 implants (13.3%), additional bone-augmentation or sinus elevation procedures were required. Early failures were recorded for 52 (4.6%) implants in 33 patients (6.5%). Smoking, male gender, total edentulism, implant diameter, and bone augmentation surgery were found to be associated with early implant failure. Conclusion: Patients referred for implant placement were more likely to be partially edentulous and older than 50 years. Singletooth replacement in the posterior mandible was the most frequent indication (24.4%) for treatment. This study found an early success rate of 95.4% and identified risk factors for early failures.
... [1] DeLuca et al. from their 10-year follow-up study found significantly higher failure rate in smokers than nonsmokers. [8] However, some authors stated that smoking is not considered as an absolute contraindication in dental implant cases. [1] The present retrospective study was done to assess the effect of smoking on survival rate of dental implant. ...
Article
Aims and Objectives: Osseointegrated implants are used in replacement of missing teeth. Survival rate of implant depends on many factors including oral hygiene, implant material used, bone quality, and personal oral habit such as smoking. The present retrospective research was conducted to assess the effect of smoking on survival of dental implant. Materials and Methods: The study participants were selected from all the patients who underwent for dental implant in implant center from 2005 to 2015. For each patient, various information regarding implant characteristics and smoking habits were recorded. The readings were statistically evaluated by SPSS statistical software by IBM version 21 and using Chi-square test at P ≤ 0.01. Results: In our study, the age range of patients was between 30 and 54 years. There were 2142 (57.2%) male and 1579 (42.4%) female participants, in that 72.2% were nonsmokers and 27.7% were smokers. Implant placed more in mandible (2312, 62%) than in maxillary region (1409, 37.8%). From 3721 patients, 3600 were successful and 121 failures. Success of implant was considerably more in nonsmokers than smokers. Implant failure rate was more in smokers with increased frequency and duration of cigarette smoking habit, but it was statistically not significant. In the present study, we have observed 0.049% mobility in smokers compared to 0.007% in nonsmokers. Conclusion: The present study showed that higher risk of implant failure was associated with long term and increased frequency of smoking due to bone resorption. © 2017 Journal of International Oral Health | Published by Wolters Kluwer - Medknow.
... Previous studies have reported that bone volume is an important factor for implant survival and this could also reflect on differences in implant length, a factor also acknowledged as important for the survival of dental implants. [51][52][53][54] These findings agree with previous studies that found that high primary stability is important. 10 One could also argue that primary stability could be used as a proxy for bone density, a variable that surgical techniques could address and sometimes compensate for. ...
Article
Full-text available
Background Dental implants provide anchorage for dental prostheses to restore functions for individuals with edentulous jaws. During the healing phase, proper osseointegration is required to prevent early implant failure. More knowledge is needed regarding factors related to early failure of dental implants. Purpose The aim of the present study was to identify possible risk factors for early implant failure, with respect to anamnestic and clinical parameters. Materials and Methods All patients with edentulous jaws with early implant failure (n = 408) from one referral clinic were compared with a matched control group (n = 408) with no implant failure. Early implant failure was identified during the first year of prosthetic function. Matching was performed on age, gender, year of surgery, type of jaw, and type of implant surface. In addition, data on anamnestic and clinical parameters were collected. The data were analyzed with a multivariable logistic regression model using early implant failure as the binary outcome. Results Five anamnestic factors were statistically significant with respect to higher probability for early implant failure: systemic disease, allergies in general, food allergies, smoking, and intake of analgesic medication. Four clinical conditions (i.e., implants in the opposing jaw, low primary stability, reduced bone volume, and healing complications) were also related to higher probability for early implant failure. Conclusions This study identified nine factors associated with early implant failure, several related to patient's general health. Further investigations are needed to fully understand the causality between the obtained variables and early implant failure.
... Heavy smoking is a known risk factor for periodontitis, bone loss and tooth loss [37][38][39]. As such, it is not surprising that smokers have a higher incidence of implant failure compared to non-smokers [40][41][42][43][44], and the effect of smoking on implant survival was more pronounced in patients with soft bone [45]. The adverse effect of smoking on the health of peri-implant tissue was found to be dose-dependent [46]. ...
Article
Full-text available
Oral reconstruction using dental implants has improved the function and quality of life for many patients. High success rates for dental implants have been reported, however, failure of implants, although rare, is a reality. This review aims to discuss the factors that contribute to implant failure and peri-implant diseases.
... Furthermore, studies have suggested that nicotine harms human periodontal ligament cells and gingival fibroblasts by increasing the generation of inflammatory mediators and compromising cellular proliferation [21,22]. Regardless of its harmful effects on peri-implant and periodontal health, cigarette smoking is not an absolute contraindication to dental implant treatment [23]. ...
Article
Full-text available
To examine the association between self-perceived pain (SPP), clinical and radiographic peri-implant parameters, and biomarker levels among smokers and never smokers with and without peri-implantitis. Sixty individuals (20 smokers with peri-implantitis [group-1], 20 never smokers with peri-implantitis [group-2] and 20 never smokers without peri-implantitis [control-group]) were included. SPP was evaluated using a numeric pain rating scale (NPRS). Peri-implant plaque index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded. After obtaining the samples, the levels of TNF-α, MMP-1, and IL-8 were measured. The mean SPP score in group-1, group-2, and the control group was 1.3 ± 1, 3.4 ± 1, and zero, respectively. The peri-implant mean PD (p < 0.05), BOP (p < 0.05), PI (p < 0.05), and crestal bone loss (CBL) (p < 0.05) were significantly higher among test groups than the control group. The levels of TNF-α, MMP-1, and IL-8 were significantly raised among group-1 and group-2 than the control group. A significant correlation between increasing SPP and PICF TNF-α, MMP-1, and IL-8 levels was observed based on regression analysis. Proinflammatory biomarkers were higher in smokers with peri-implantitis than never smokers with and without peri-implantitis, with a significant association between the proinflammatory cytokines and SPP.
... The modern dental implant continues to serve as a successful intervention in a wide variety of clinical scenarios. However, implant prognosis can be compromised by local factors such as highly cancellous bone (Chrcanovic, Albrektsson, & Wennerberg, 2017;He, Zhao, Deng, Shang, & Zhang, 2015) and systemic patient-related factors including poorly controlled diabetes and smoking (DeLuca, Habsha, & Zarb, 2006;Moy, Medina, Shetty, & Aghaloo, 2005). ...
Article
Objectives The objective of this study was to determine the relative osteogenic behavior of titanium implants with or without a porous tantalum modification when placed with a gap between the implant and existing bone. Materials and Methods A gap‐healing model in the rabbit tibia was used for placement of titanium implants. Forty‐eight rabbits received 96 implants, with 48 of the implants containing a porous tantalum middle section and the remaining 48 implants were composed of solid titanium. After 4, 8 and 12 weeks of healing, biomechanical stability was measured with removal torque testing, implant‐adherent cells were isolated for analysis of osteogenic gene expression, and histomorphometric analysis was performed on sections of the implants and surrounding bone. Results Increased osteogenic activity at 4 weeks was demonstrated by upregulation of key osteogenic genes at implants containing porous tantalum which was accompanied by greater bone‐implant contact at 4, 8 and 12 weeks and significantly greater removal torque at 8 and 12 weeks. Conclusions Implants containing porous tantalum demonstrated increased peri‐implant bone formation within this gap‐healing model as shown by significant differences in biomechanical and histomorphometric outcomes. Such implants may represent an alternative to influence bone healing in surgical sites with an existing gap. This article is protected by copyright. All rights reserved.
... A meta-analysis by Clementini et al. [23] reported that smoking increases MBL around implants by 0.16 mm per year, and a long-term retrospective study by Levin et al. [24] concluded that MBL was more severe in smokers compared to non-smokers at all assessed time periods. DeLuca et al. [25] demonstrated more MBL in smokers than non-smokers over a 10 year follow-up period, and concluded that localized exposure of peri-implant tissue to cigarette smoke is the main factor causing the higher implant failure rates observed in smokers as compared to non-smokers. Furthermore, based on their systematic review and meta-analysis of smoking and dental implants, Chrcanovic et al. [26] suggested that smoking affects the rate of implant failure as well as the incidence of postoperative infection and amount of MBL following implant insertion. ...
Article
Full-text available
BACKGROUND Smoking may be a risk factor for marginal bone loss (MBL) and oral mucosal inflammation surrounding dental implants. This retrospective study evaluated the effects of smoking on dental implants in patients with fixed implant-supported prostheses over a period of 36 months following loading. MATERIAL AND METHODS We assessed 120 patients (68 women, 52 men, ages 19-74 years (mean age: 55.10 years) with 315 implants. Implants were classified according to location in the upper and lower jaws and anterior (placed between canines) or posterior (placed between pre-molars and molars) as follows: 1=maxilla anterior, 2=maxilla posterior, 3=mandible anterior, 4=mandible posterior. We also measured MBL, plaque index (PI), sulcus bleeding index (SBI), and probing depth (PD). P-values less than 0.05 were considered statistically significant. RESULTS MBL was statistically greater in smokers (P<0.001) as compared to non-smokers in both jaws. MBL did not vary significantly by location in either group (smokers: p=0.415; non-smokers: p=0.175). Mean PI and PD scores were significantly higher in smokers as compared to non-smokers (P<0.001). A positive correlation was found between PI and PD scores in both groups. No statistically significant difference in SBI was observed between the 2 groups (P>0.05). CONCLUSIONS Smoking was associated with increases in marginal bone loss around implants, independent of their location in the jaws. Also, both plaque indices and probing depths were greater in smokers than in non-smokers.
... Nicotine content of tobacco is the key factor which affects bone health and cellular proliferation. 1 DeLuca et al. from their ten-year follow-up study observed a significantly greater failure rate in smokers than nonsmokers. 8 However, some researchers concluded that smoking is not measured as an outright contraindication in dental implant cases. 1 The present prospective study was done to evaluate the effect of smoking on dental implant survival rate. ...
... [7] DeLuca et al. from their 10-year follow-up study found significantly higher failure rate in smokers than nonsmokers. [8] The current retrospective study was done to evaluate the effect of smoking on survival rate of dental implant. From the collected data, success or failure of implant was evaluated based on smoking habit (frequency, duration), non-smoking habit, implant condition, and mobility. ...
... However, a combination of smoking, poor oral hygiene and history of periodontitis had been observed for that patient. Patients should be informed that smoking during the initial healing phase following implant insertion and/or a history of significant smoking increases the risk for implant failure 58,59 . ...
Article
Purpose: To assess the technical and biological complications of screw- and cement-retained implant-supported full-arch dental prostheses. Materials and methods: An electronic search was conducted on Medline/PubMed and Cochrane databases in February 2019; irrespective of any time restrictions using MeSH terms. All studies were first reviewed by abstract and subsequently by full-text reading. Further hand search was performed to identify other related references. Articles only related to cement-retained and/or screw-retained reconstructions in full-arch fixed dental prostheses (FDP) were included. Results: The initial literature search resulted in 3670 papers. 3478 articles remained after removing duplicate articles, and 3439 articles were further excluded by the reviewers after the abstract screening, which resulted in a selection of 39 studies. 12 studies were further excluded due to not fulfilling the inclusion criteria. Hand searching resulted in two additional papers being included, and finally, 29 articles were included in this review. Screw-retained full-arch fixed dental prostheses have fewer complications than cemented reconstructions. Biological complications such as marginal bone loss > 2 mm occurred more frequently in cemented reconstructions, and technical complications such as screw-loosening and screw fracture occurred more in screw-retained reconstructions. Conclusion: Cemented reconstructions exhibited more biological complications (implant loss, bone loss > 2 mm) and screw-retained prostheses exhibited more technical problems. Clinical outcomes were influenced by both fixations in different ways. The screw-retained restorations were more easily retrievable than cemented ones, therefore, technical and eventually biological complications could be treated more easily. For this reason, and for their higher biological compatibility, these reconstructions are preferable.
... This matrix is an early-formed calcified afibrillar layer on the implant surface, involving poorly mineralized osteoid similar to the bone cement lines and laminae limitans that forms a continuous, 0.5 mm thick layer that is rich in calcium, phosphorus, osteopontin, and bone sialoprotein. [8][9][10] In the oral cavity, the smoking habit is associated with delayed bone healing, reduced bone height, increased rate of bone loss, formation of poor quality bone as well as increased incidence of peri-implantites. [11] Smokers present 1.69 times higher chances of implant failures than nonsmokers during the first implant surgical stage (before prosthesis insertion). ...
Article
Full-text available
Background: The overall success of osteointegrated dental implants depends on various factors. The deleterious effects of smoking on wound healing after the tooth extraction and its association with poor quality of bone are well documented. Similar effects of tobacco use on the success of dental implants are expected. Cigarette smoke mainly contains nicotine that delays the bone healing and increases the rate of infections at the implant insertion site. Aim: The purpose of the present study was to evaluate and compare the marginal bone loss around dental implants in smokers and nonsmokers. Materials and methods: The study was conducted on 500 individuals who received dental implants in maxillary or mandibular edentulous regions from 2010 to 2017. The sample was divided into two groups: Group I (smokers, n = 280) and Group II (nonsmokers, n = 220). Marginal bone loss was measured on mesial, distal, buccal, and lingual side of each implant using periapical radiographs 3 months after loading, 6 months after loading, and 12 months after loading. Results: The crestal bone loss around dental implants was significantly greater in smokers (Group I) as compared to nonsmokers (Group II) irrespective of the duration of loading (P < 0.001). Marginal bone loss did vary significantly by location in either groups. Conclusion: Smoking overall lowers the success rate of dental implants. Increased duration and frequency of smoking leads to a greater degree of marginal bone loss around dental implants.
... Bain and Moy, (1993) also hypothesized that if smoking is stopped, prior to implant placement, for a period of 8 weeks, it would enable healing of bone and osseo-integration. Deluca et al., (2006) also suggested that smoking ceassation improves chances of successful osseo-integration. According to the study patients who stopped smoking one week prior to implant surgery showed lower incidence of early implant failures as compared to smokers who showed 1. 2008) concluded that smoking alone cannot be considered as a risk factor related to early implant failure. ...
Article
Full-text available
Background: Despite the fact that dental implant therapy is a very successful treatment, various studies have suggested higher Implant failure rates in smokers. The aim of this study is to assess whether smokers are at an increased risk of implant failure and peri-implantitis, as compared to non-smokers. Methods: A comprehensive search on PubMed, Cochrane library and Web of Science was conducted to identify studies investigating the association between smoking and peri-implantitis and implant failure. Only studies published between 1990 and 2016 were considered in this review. Results: From the 920 search results initially retrieved, only 20 were selected after analysis of the abstracts and titles. The quality of the included papers was assessed using the Quality Assessment Tool for Quantitative Studies. It was found that the quality rating for most of the studies included was moderate or strong. The majority of the included studies showed a relationship between cigarette smoking and dental implant failure. Conclusion: The results from the included studies showed that smoking is an important risk factor for dental implant failure. However high quality studies with additional robust epidemiological and clinical investigations are required to confirm the association between the two.
... ISSN: 2377-987X a higher risk of failure during the initial healing time aft er surgery, some authors like Chrcanovic et al. (2015) reported that this depends on the implant surface's roughness [16][17][18][19]. Th e patient in the current case report reduced the number of cigarettes smoked per day before performing the treatment, which could be considered as the fi rst key factors for the long-term success of it [20] (Figures 14-19). ...
Article
Full-text available
Periodontal disease is one of the most common oral diseases, caused by a combination of poor oral hygiene and host defense response. It can be infl uenced by genetic, environmental and/or developed conditions such as smoking and diabetes mellitus. Periodontitis leads to bone resorption and has a reported relationship with peri-implantitis development and implant failure. However, when sugar levels are controlled, even diabetic patients can have a long-term success and survival of dental implants. In addition, the patient's ability to maintain a good oral hygiene has been reported as a critical factor to achieve that goal. Dental implants are a good option for these patients, although there are some factors that should be ensured prior to the treatment, such as improvement and maintenance of oral hygiene levels, compliance in disease-control and quitting or reducing of smoking. The purpose of this case report with 5 years follow-up is to review the importance of motivation, education and maintenance in a patient who received dental implants as a type I diabetic with a history of chronic heavy smoking and poor oral hygiene.
... [29][30][31] Several authors have also stated that there is a considerably higher failure rate in type III and type IV bones, which are also mostly found in the posterior maxillary region. 1,27,[32][33][34] Given the challenges and the ineffective ground work that the posterior maxillary presents, it is important to note that the proposed technique also holds a promising value as it can be used to achieve a much lower failure rate of implants in this region. ...
Article
Abstract Over the years, there have been a series of innovative approaches to the alveolar bone augmentation techniques. These have led to the modifications of the existing methods and the establishment of more efficient ways to obtain sufficient bone mass that is necessary for the implant procedure. The aim of this paper is to propose a novel augmentation technique, and to investigate its efficacy, particularly during the healing process of the maxillary alveolar bone prior to the implant treatment. During the application of the proposed methodology, first, the ridge-split technique was applied to the posterior maxilla. Then, a horizontal augmentation procedure was performed with an autogenous bone graft. Implants were placed at the second month of the surgery. Prosthetic rehabilitation was completed after the osseointegration of the implants. The technique was compared with the ridge-split method with simultaneous implant placement in 14 patients. The groups were divided into 2, the control group and the experimental group, each containing 7 patients. The aimed success criteria for the status of the endosteal implants were fulfilled and there were not any complications observed in the second year of follow-up. The basic practical innovation offered by the proposed surgical technique is to achieve the required horizontal dimension and to change the quality of the bone conveniently. The press-fit insertion leads to multipoint contact healing of the transported bone and the use of cortical block bone in posterior maxilla, led to a significantly advantageous higher stability level for both the placement and the survival of the implants.
... Stephelynn, et al., [33] in a long-term retrospective study evaluated, the survival of branemark endosseous 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 were part of a surgical/prosthodontic prospective treatment outcomes study. ...
Article
Full-text available
The use of dental implants has revolutionized the treatment procedure for over last 25 years. Implants now have been widely accepted by patients as their treatment plan and have become a routine procedure by dental surgeons. Owing to the remarkable success, there have been various researches going on to find out factors responsible for the failure of implants. With the growing use of tobacco among patients, its ill effects on bone quality and quantity it arises a keen interest to associate effect on the success of implants. To establish a relationship between smoking and implant success and its long term survival and compare the result with non‑smokers based on the literature. Relevant clinical studies and reviews published in English literature published between 1990 and 2012 were reviewed. The articles were located through EBSCO host and manually through the references of peer reviewed literature. Most of the literatures supported the fact that smoking is a prominent risk factor affecting the success of implants. Studies reported that implant failure and its complications associated are twice in smokers as compared to non‑smokers. Literatures also revealed that maxillary implant are more affected than mandibular in smokers. Studies suggested that effects of smoking were reversible in smokers who followed the smoking cessation protocol prior to the procedure. Smokers have a greater chances of implant failure and more prone to the complications following implants and related procedures. Surgeons should stress on counseling of patient willing for implant for smoking cessations protocols.
... Clinical studies have strongly suggested that smokers present a 1.69 times higher incidence of implant loosening compared to non-smokers during the first healing period before prostheses insertion. Furthermore, smoking has also been shown as a risk factor for delayed failures of implants, which might occur during the second stage of implant surgery 25,26 . However, in this retrospective study, we only analyzed implants that successfully survived in cases where all the implants had the same amount of marginal bone levels around the cervical collar regions at the time of prostheses insertion. ...
Article
Full-text available
Introduction Implantology has led to several changes in the planning process involved in the application of dental prostheses to diminish bone level changes along the margins of dental implants. However, the relationship between smoking and marginal bone loss around dental implants, supporting both fixed and removable prostheses, has not been investigated. We hypothesize that the design of different prostheses alter the effects of smoking, which consequently affects the amount of supporting alveolar bone. Methods In this study, we included 137 implants in the ‘implant-supported fixed prostheses’ (ISFP) group (31 smokers, 106 non-smokers) and 94 implants (21 smokers, 73 non-smokers) in the ‘implant-supported removable prostheses’ (ISRP) group. The corresponding patients were examined in routine recall sessions conducted at 6, 12 and 24 months after the placement of the dental prostheses. The recorded clinical periodontal parameters were the presence/ absence of a plaque index, bleeding index, and the probing depths. These periodontal parameters were assessed in conjunction with marginal bone level measurements. Comparative bone level measurements were obtained from radiographical images at ×20 magnification using the CorelDraw 11.0 software program. Statistical analysis was performed using the SPSS Statistical Software version 21.0. Results The overall clinical parameters were found to be poorer in smokers than in non-smokers (p
... In the patient population with non-head and neck cancer, cigarette smoking has been shown to increase the risk of dental osseointegrated peri-implantitis, marginal bone loss, mucositis, and implant failure. 5,[28][29][30][31] In the patient population with head and neck cancer, cigarette smoking has been shown to increase risk of ORN after oral implant placement, 15 and increase the risk of peri-implant skin reaction in temporal bone implants for auricular defects. 32 In the current study, we found that implants placed in nonsmokers had a statistically insignificant implant survival advantage when compared to smokers (ex-smokers, and current smokers combined) (P = .11; ...
Article
Full-text available
Background: Treatment of head and neck cancer may result in disfiguring and debilitating anatomical changes. Osseointegrated implants may be used in these patients to facilitate attachment of implant-retained dentures or cosmetic prostheses. Methods: A retrospective audit was performed, reviewing the treatment of patients who received dental or craniofacial osseointegrated implants during treatment of head and neck cancer. Results: One hundred sixty implants were inserted in 54 patients with oral, nasal, orbital, or auricular defects. Overall, 85% of implants were successful after mean follow-up of 25.7 months. The brand of implant used was shown to impart a statistically significant implant survival difference, and orbital implants had poorer survival compared to nonorbital implants. There was a statistical insignificant implant survival advantage in both nonsmokers and patients who did not undergo radiotherapy. Conclusions: Dental and craniofacial osseointegrated implants may be reliably used in patients with head and neck cancer. However, further research is required to clarify the role of smoking in osseointegrated implant failure.
Chapter
Keywords:Aesthetics, phonetics and temporomandibular assessment;Maxilla and mandible;Occlusion, tooth guidance and dentures;Oral cleanliness, saliva and dentures;Oral health;Orthopantomogram;Removable dental prosthesis (RDP);Soft tissues
Article
Background: Smoking impose various ill-effects on the alveolar bone concerning dental implants including reduced bone height, delayed healing of bone, poor peri-implant bone formation, increased bone loss, and peri-implantitis. Aims: The present clinical trial was aimed to analyze the smoking effect on dental implant survival rate as well as marginal bone loss in dental implants. Materials and methods: Out of 86 patients, Group I had 43 patients who were smokers and Group II had nonsmokers. Following the implant placement, marginal bone loss radiographically and mobility were assessed clinically at 3, 6, and 12 months after implant loading. Results: The mean marginal loss seen in smokers at 3 months was 2.13 ± 0.21, 2.46 ± 0.09, 2.60 ± 0.0.92, and 2.74 ± 0.11 for maxillary anterior, maxillary posterior, mandibular anterior, and mandibular posterior regions, respectively. The 12-month recall visit showed a higher proportion of smokers having implant mobility. In smokers, 13.95% (n = 6) of the study participants had implant mobility, whereas 6.97% (n = 3) of the nonsmokers had mobility. Conclusion: Smoking is associated with long-term implant failure which is directly proportional to the duration ad frequency of smoking. Furthermore, smoking has a detrimental effect on dental implants and its surrounding bone.
Article
The outcome of the osseointegrated implant is influenced by various conditions, one of which is smoking. Literature shows conflicting results for the association between smoking and implant success. Hence, the study was conducted to assess the effects of smoking on survival and marginal bone loss of osseointegrated implants. Literature search of published articles in Medline, Scopus, Ovid, and Journal of Web till June 2020 were analyzed for the determined outcomes. Revman 5.4 software was used for the analysis of the study. Of the 437 articles screened, nine were chosen for review and analysis. Meta-analytic results showed that implant success rate was better in nonsmokers than smokers (odds ratio = 0.43, 95% confidence interval = 0.26-0.72, P < 0.0001). Smoking habit does seem to affect the implant outcome of survival and marginal bone loss negatively.
Research
Full-text available
With the intention of clarifaying the current concept of the pathogenesis of the periimplantitis and the implications that bacteria could have in it, an extensive literature review has been made. Till the date, different longuitudinal and cross-sectional studies have identified some of the periimplantitis risk factors or risk indicators. Factors as history of periodontitis, diabetes, genetic traits, poor oral hygiene, smoking, alcohol consumption, absence of keratinized mucosa and implant surface have been analyzed in detail. The colonization of the surgical implanted new surfaces act as a risky situation for partial edentulous patients, where periodontopathogenic bacteria of the residual pocket have and important role. KEY WORDS: Periimplantitis, pathogenesis and risk factors.
Article
Introduction: To evaluate risk indicators associated with implant failure and relationship between bone levels and soft-tissue health of anodized implants placed in private practice. Material and methods: Partially or completely edentulous patients who received an anodized implant between 2003 and 2013 were included. Univariate and multivariate analysis was used to identify the relationship between study variables and implant failure. Mean marginal bone level changes (MBLΔ) were assessed using periapical radiographs. Periimplant soft tissue was evaluated using a modified bleeding index (implant mucosal index, IMI). Results: A total of 1087 implants placed in 414 patients were followed for 3.9 ± 2.7 years. The cumulative implant survival rate after 10 years of function was 97.0%. Shorter (P = 0.0068) and maxillary implants (P = 0.0314) were associated with lower implant survival rate. Mean MBL decreased from -0.16 ± 0.43 mm at baseline to -0.53 ± 0.53 mm 8 to 10 years later. Implants with healthier mucosa were associated with less bone loss. Conclusions: Implants with an anodized surface showed a high long-term survival rate in a daily practice. Longer implants and implants placed in the mandible were associated with greater survival. Immediate loading and tapered design did not affect implant survival. Profuse multipoint bleeding and suppuration on recall were associated with greater bone loss.
Article
Full-text available
Through an extensive review of the literature, our objective will be to clarify the current concept that exists about the pathogenesis of peri-implantitis, as well as the implications that bacteria may have on it. To date, different longitudinal and cross-sectional studies have identified some of the risk factors or risk indicators of peri-implantitis. Previous history of periodontal disease, diabetes, genetic load, poor oral hygiene, tobacco, alcohol consumption, absence of keratinized gingiva and the surface of the implants are some of the factors that have been analyzed in detail in the literature. The colonization of new surgically implanted surfaces represents a risk situation in partially edentulous patients, where periodontopathogenic bacteria from the residual bag play an important role.
Article
Full-text available
Introducci?n: La terapia odontol?gica con implantes es un tratamiento que debe tener planeaci?n quir?rgica y prot?sica adecuada para evitar fracasos. Entre los factores que influyen en el ?xito de los implantes se encuentran la condici?n del paciente, las caracter?sticas del sitio receptor y de la t?cnica, y el tipo de rehabilitaci?n prot?sica. Objetivo: Identificar los factores que contribuyen al ?xito o al fracaso de los implantes colocados en el Posgrado de Prostodoncia e Implantolog?a de La Salle Baj?o. Materiales y m?todos: Se evaluaron 371 implantes colocados por los residentes del Posgrado de Prostodoncia e Implantolog?a de la Universidad de La Salle Baj?o a partir del a?o 2010 hasta el mes de junio del 2014. Para determinar los factores relacionados con la colocaci?n se rellen? una hoja de control para cada uno de ellos donde se describ?an los datos del paciente, la condici?n sist?mica, las caracter?sticas del implante y los procedimientos de la fase quir?rgica. Para evaluar los resultados se realiz? un an?lisis estad?stico de regresi?n log?stica m?ltiple. Resultados: De los 371 implantes colocados, se registr? el fracaso de 19 implantes previos a la fase prot?sica, con una tasa de ?xito del 95%. No se observ? que la condici?n sist?mica del paciente influyera en el ?xito de los implantes, sin embargo, el tabaquismo intenso (m?s de 10 cigarros al d?a) s? influy? (p?=?0,0001). Otros factores que se relacionaron con la tendencia al fracaso fueron la colocaci?n del implante en una cirug?a sin colgajo (p?=?0,02) y que se hubiera colocado con un torque menor a 15?Nm (p?=?0,0001). Conclusiones: Seg?n los datos recabados en esta investigaci?n, se observ? que los factores de riesgo para el fracaso en implantes son el tabaquismo, la poca o nula estabilidad primaria y la cirug?a sin colgajo.
Article
Dental implants are regularly placed in patients with a history of periodontitis, even though peri-implant tissues are susceptible to the same host-modulated plaque-induced factors that initiate and sustain periodontitis. This article endeavors to clarify the evidence regarding the history of periodontitis as a risk factor for implant success and survival, and the role of supportive periodontal therapy in maintaining implants for individuals with a history of periodontitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Chapter
The long-term survival rates of implants and implant-supported restorations are known to be high. However, complications and implant failure can still occur and are considered by many clinicians as a major obstacle for implant treatment. In spite of recent improvements, implant therapy still includes a biological healing and integration process. These biological processes are multifactorial and can be impaired by local or systemic factors leading to complications that may result in implant failure. Major etiological risk factors such as smoking, poor bone quality, tREFIID trauma and occlusal overload have been associated with increased implant failure. The importance of managing patients with those risk factors and being able to address possible complications and failure is essential for the implant surgeon and dental practitioner. The prevalence, etiology, risk factors, prevention and management of implant failure are discussed in the chapter with a thorough review of the literature published on this topic.
Research
Full-text available
Objetivo: Determinar el porcentaje de éxito y la remodelación ósea marginal de implantes con superficie Oxalife® a un año de la inserción, en pacientes adultos fumadores y no fumadores. Además determinar el porcentaje de éxito en relación a cantidad de cigarrillos fumados, maxilar, zonas en cada maxilar, el largo y diámetro de los implantes, edad, género e higiene oral. Materiales y Métodos: se colocaron 87 implantes Tree-Oss® (MicromedSystem S.A. Capital Federal –Argentina) anatómicos cónicos, de conexión externa, con superficie Oxalife® (Blasting, grabado y tratamiento de superficie), de diferentes longitudes (8, 10, 11.5, 13 y 16mm) y diámetros (4.3mm y 5.1mm) en 21 pacientes adultos y de ambos sexos. Los mismos fueron colocados en maxilar superior e inferior. 42 implantes se colocaron en pacientes fumadores (n= 8) y 45 implantes en no fumadores (n=13). Los pacientes fumadores fueron subdivididos en dos grupos: fumadores entre 1-10 cigarrillos diarios (4 pacientes), fumadores de 11 o más (4 pacientes). Se realizaron controles clínicos y radiográficos. Los datos fueron sometidos a pruebas estadísticas específicas Prueba de Chi2 de Pearson, se calculó el riesgo relativo (RR.) y se usó un intervalo de confianza (IC) de 95% para el riesgo de éxito en pacientes no fumadores. También se utilizó Test de Student y correlación de Spearman. Resultados: La tasa de éxito fue del 100% en pacientes no fumadores y del 95.2% en pacientes fumadores, aunque esta diferencia porcentual no resultó significativa estadísticamente (p= 0.139). Según la influencia de las variables: cantidad de cigarrillos: la tasa de fracaso fue del 9.1% en pacientes muy fumadores (11 a 22 cigarrillos), la diferencia porcentual entre los grupos resultó significativa estadísticamente (p= 0.049), así como la correlación entre la cantidad de cigarrillos y la tasa de fracaso en implantes. Género: La tasa de fracaso fue del 18.2% en mujeres fumadoras (2/9). La diferencia estadísticamente significativa (p=0.003). Maxilar: La tasa de fracaso fue del 14.3% en mandíbula de fumadores (2/14) en contraste con el maxilar, cuya tasa de fracaso fue 0.0%. La diferencia fue significativa (p=0.014). Zonas: La tasa de fracaso fue del 8.3% en zona posteriores de fumadores (2/23), en contraste con los demás grupos (0,0%). La diferencia no resultó estadísticamente significativa (p= 0.146). Higiene oral: La tasa de fracaso fue del 7.7% en pacientes fumadores con buena higiene oral (2/26), contra 0% en pacientes con higiene regular. (0.0%). La diferencia no resultó estadísticamente significativa (p= 0.187). Diámetro: La tasa de fracaso en implantes de 4.3mm fue del 3.4% y de 7.7% en implantes de 5mm de diámetro en fumadores, en los demás grupos, la tasa de fracaso fue 0.0%. La diferencia porcentual entre estos subgrupos no resultó estadísticamente significativa (p=0.405). Longitud: La tasa de fracaso en implantes cortos (8mm) fue del 33.3% en pacientes fumadores, y del 0% en no fumadores. Al considerar implantes mayores a 8mm de largo, la tasa de éxito fue de 97,4% en fumadores en los pacientes no fumadores la tasa de éxito fue del 100%. La diferencia porcentual entre estos subgrupos resultó estadísticamente significativa (p= 0.003). Edad: La tasa de fracaso en implantes en pacientes fumadores menores a 65 años fue del 5.3%, y de 0% en el resto. La diferencia porcentual entre estos subgrupos no resultó significativa estadísticamente (p= 0.452).Niveles Crestas Óseas: La modificación del nivel de hueso fue de 0,448 en no fumadores y de 0,302 en fumadores. De acuerdo a la medición del hueso dio como resultado en un periodo de un año por mesial en pacientes fumadores una pérdida de hueso de 1.17 y por distal 1.30. La diferencia no fue significativa. (Test de Student para muestras independientes: p>0.05). Conclusión: El porcentaje de éxito de implantes de superficie Oxalife® fue 100% en pacientes no fumadores y del 95.2% en pacientes fumadores sin diferencias estadísticamente significativas en un año de seguimiento. El nivel de hueso estuvo acorde con la literatura y las diferencias no fueron estadísticamente significativas entre fumadores y no fumadores. Las variables género, cantidad de cigarrillos, maxilar y longitud influyeron significativamente en la tasa de éxito de fumadores y no fumadores. Por el contrario, la zona, la higiene, el diámetro de los implantes y la edad de los pacientes no mostraron diferencia significativa. PALABRAS CLAVES: superficie Oxalife, hábito de fumar, nivel óseo, tasa éxito, tasa fracaso.
Article
Background: Dental implant therapy is a treatment of choice in missing teeth. However, certain conditions such as smoking, hypertension, and diabetes have negative influence on success of dental implants. Nicotine is found to cause osteoclastic changes. The present study was conducted to assess the relationship between nicotine and implant failure. Materials and methods: The present retrospective study included 2570 patients of both genders. They were divided into two groups. Group I consisted of 1250 patients with a history of smoking and Group II were nonsmokers and comprised 1320 patients. The presence of pain, mobility, and inflammation was considered positive signs for implant failure. Results: The results showed that in Group I, males had 6.13% and females had 5% dental implant failure. Overall failure rate in Group I was 5.56%. In Group II, males had 2.98% and females had 0.9% failure. Overall failure rate in Group II was 2.35%. The difference between both groups was statistically significant (P < 0.05). In Group I, maximum (56), and in Group II, 18 patients had habit of >10 years of smoking. Maximum patients had habit of consumption of >20 cigarettes/day (Group I) and Group II had only 10 patients with this frequency. Maximum dental implant failures were observed in maxillary arch (70) than in mandibular arch (32). The difference was statistically significant (P < 0.05). Conclusion: Smoking influences the survival rate of dental implants. Thus, patient should be educated to discontinue the habit before implant placement.
Article
With the intention of clarifaying the current concept of the pathogenesis of the peri-implantitis and the implications that bacteria could have in it, an extensive literature review has been made. Till the date, different longuitudinal and cross-sectional studies have identified some of the peri-implantitis risk factors or risk indicators. Factors as history of periodontitis, diabetes, genetic traits, poor oral hygiene, smoking, alcohol consumption, absence of keratinized mucosa and implant surface have been analyzed in detail. The colonization of the surgical implanted new surfaces act as a risky situation for partial edentulous patients, where periodontopathogenic bacteria of the residual pocket have and important role.
Article
Purpose: The aim of this review was to assess the effect of implant shape (tapered vs cylindrical) on the survival of dental implants placed in the posterior maxilla. Methods: Databases were searched from 1977 up to and including February 2015 using various key words. Only original clinical studies were included. Experimental studies, letters to the editor, review articles, case reports, and unpublished literature were excluded. The pattern of the present review was customized to mainly summarize the relevant information. Results: Five studies were included. The number of patients included ranged between 4 and 29 participants. In total, 7 to 72 implants were placed in the posterior maxilla. Tapered and cylindrical shaped implants were placed in 1 and 1 study, respectively. In 1 study, both 41 tapered and cylindrical implant were placed. In all studies, rough-surfaced and threaded implants were used. Three studies reported the diameter and lengths of implants placed, which ranged between 3.75 to 4 mm and 10 to 20 mm, respectively. The mean follow-up period and survival rate of implants ranged between 19 and 96 months and 84.2% to 100%, respectively. In 1 study, implants were placed subcrestally in the posterior maxilla. Guided bone regeneration was performed in none of the studies. In all studies, participants were nonsmokers and were systemically healthy. Conclusions: There is no influence of implant shape on the survival of implants placed in the posterior maxilla.
Chapter
Implant Design is a fundamental aspect of successful implant treatment. Its evolution has led to the development of 1000s of implant types manufactured by an ever increasing number of companies in both industrialized and developing countries. Implant body shapes can generally be classified into threaded,tapered or stepped designs and further subdivided into surface chemistry and material composition. Improvements in implant design and its composition has prompted a rethink of selection criteria for different clinical scenarios, an example being the use of short implants to avoid the need of advanced bone grafting techniques. Objective analysis if data from the used of short and varying implant diameter need to be carried out to allow a fair comparison of this trend and how it compared to the long term predictability that has been achieved with traditional implant lengths.
Article
Full-text available
Smoking is a major risk factor for developing atherosclerosis. In order to understand the vascular abnormalities observed in smokers, we investigated vascular responsiveness in cigarette smokers. We performed two consecutive matched group comparative studies to investigate vascular responsiveness using venous occlusion plethysmography. The mean effects of three incremental doses of each vasoactive agent are presented. Both studies compared smokers with nonsmokers. The first investigated 68 subjects (smokers = 29; mean +/- s.d. ages; 24 +/- 6 vs 25 +/- 5 years; P = NS) and found smoking was associated with a significant blunting of the flow ratio between treated and untreated arms to endothelium-dependent vasodilatation to acetylcholine (mean +/- s.d., nonsmokers vs smokers) 4.07 +/- 2.18 vs 3.42 +/- 1.79 (P = 0.04, 95% CI 0.02, 1.12). By contrast, there was no significant difference in the responses to the endothelium-independent vasodilators sodium nitroprusside and verapamil. Smoking was also associated with a significant impairment in endothelium-dependent vasoconstriction induced by monomethyl-L-arginine (L-NMMA) 0.78 +/- 0.22 vs 0.87 +/- 0.21 (P = 0.006, 95% CI -0.14, -0.02) and a trend to blunted endothelium-independent vasoconstrictor responses to noradrenaline. In the second study we investigated the response to angiotensin I and II in 23 subjects (smokers = 12; mean +/- s.d. ages; 34 +/- 10 vs 32 +/- 11 years). There was significant impairment in smokers of the mean vasoconstrictor response to angiotensin I 0.51 +/- 0.15 vs 0.59 +/- 0.16 (nonsmokers vs smokers; P = 0.003, 95% CI -0.13, -0.03) and a nonsignificant trend towards impairment of the response to angiotensin II. Cigarette smoking in male volunteers is associated with blunted basal and stimulated nitric oxide bioactivity. Endothelial independent vasodilator responses (to nitroprusside and verapamil) were unaltered in smokers. A defect in the vasoconstrictor response to angiotensin I was also seen.
Article
Smoking has been reported to have a deleterious effect on the oral cavity. Research has associated smoking with oral cancer, periodontal disease, leukoplakia, stomatitis nicotina, and impaired gingival bleeding. In 1991 the Dental Implant Clinical Research Group initiated a prospective, randomized clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on long-term clinical performance and crestal bone height. Over 70 dental and medical history variables and exclusion factors were analyzed to determine relationships, if any, with implant failure at the time of second-stage surgery. The variables were analyzed separately for individual implants, cases (prostheses), and patients. The cases ranged from one to five implants each, and more than one case from a single patient could be included in the investigation. At this interim analysis, 2,066 implants have been placed representing 433 cases in 310 patients. With regard to implant failure rates, possible exclusion variable (9) and medical history variables (39) were not found to be statistically significant. For the dental history variables (23), only the question related to smoking was statistically significant on an implant, case, and patient basis (P < 0.007). Results of this interim analysis suggest that smoking is detrimental to implant success.
Article
Fifty consecutive completely edentulous patients who were unable to wear their complete dentures took part in this prospective longitudinal study. After providing initial optimization treatment of patients' existing prostheses, prosthodontists conducting the study prescribed osseointegrated implant-supported removable overdentures for 45 of the 50 patients. The remaining five underwent ongoing attempts at optimizing their complete dentures. This article details the results of treatment for the 50 patients over a period of three to 13 years.
Article
This prospective longitudinal study follows the treatment of 50 completely edentulous patients who could not successfully wear their complete dentures. After an initial phase of treatment in which the prostheses of all of the patients were optimized, the prosthodontists conducting the study prescribed osseointegrated implant-supported fixed prostheses for 45 patients and an implant-supported overdenture for one patient. Eventually, three of the remaining four patients were treated with implant-supported overdentures. This article details the results of treatment for all 50 patients over a period of 11 to 15.5 years.
Article
Independent external monitoring committees are an important part of scientific clinical trials. They monitor patient safety, study progress, investigators' performance, and accurate interpretation/reporting of the study data. Data trends observed by a study monitoring committee detected a change in the pattern of patient screening by investigators after an increased awareness that tobacco use could directly compromise the osseointegration of root-form dental implants. This increased awareness is believed to have altered the number of active smokers accepted into a multicenter prospective dental implant study. Recent data analyses indicate that the success ratios were improved by alterations in this discretionary inclusion-exclusion criterion.
Article
The predictability and high success rate of implant treatment have averted attention from factors affecting fixture loss and bone loss around implants. The goal of this study was to retrospectively evaluate late fixture loss and marginal bone loss around implants that have been in function for 5 years and to relate these findings to bone loss in the natural dentition. One hundred and forty-three consecutively treated patients who had received an implant-anchored fixed prosthesis and completed a 5-year follow-up were selected. Intraoral and panoramic radiographs were used to assess bone loss. The bone loss was greater around remaining implants in patients who had lost implants after loading. No correlation was found between bone loss around implants and that around teeth. Only 2% of the fixtures were lost during 5 years of functional load. Most fixtures losses occurred in the edentulous maxilla. Seven of the nine patients who lost fixtures were smokers. These findings show that patients who lost implants also lost more bone around the remaining implants. There was no correlation between bone loss around implants and that around teeth, indicating that different interacting mechanisms are involved.
Article
Smoking and infection with Gram-negative bacterial pathogens are risk factors for alveolar bone loss. The aims of this study were: 1) to examine the combined effects of an aryl hydrocarbon, benzo[a]pyrene (BaP), that is concentrated in cigarette smoke, and lipopolysaccharide (LPS) extracted from Porphyromonas gingivalis on osteogenesis in a rat bone marrow cell (RBMC) model of osteogenesis; and 2) to determine whether resveratrol (Res), an aryl hydrocarbon receptor antagonist, could reverse the putative inhibitory effects of BaP + LPS on osteogenesis. LPS of P. gingivalis strain 2561 was introduced in various concentrations to the RBMC in 96-well plates and kept in culture for 8 to 12 days. The same protocol was used for studying BaP and LPS + BaP combinations. Following the incubation periods, parameters of osteogenesis were measured, including formation of mineralized bone nodules, alkaline phosphatase activity, and total cell protein. Transcription of the pro-inflammatory cytokine interleukin (IL)-1beta in the cultures was determined by reverse transcriptase polymerase chain reaction (RT-PCR). Bone nodule formation generally decreased significantly with increasing LPS concentrations (P<0.05), whereas total cell protein decreased only slightly (P>0.05). BaP in previously high concentrations alone also caused a significant dose-dependent decrease in bone nodule formation (P<0.05) but when half maximal doses were used, significant decreases were most often seen when LPS was added. Hence, in combination, the inhibitory effects of LPS + BaP on osteogenesis were additive, inhibiting bone nodule formation up to 9-fold. Resveratrol partially reversed the inhibitory effects of low concentrations of LPS alone, and completely reversed the inhibition of nodule formation when low concentrations of LPS were combined with BaP. IL-1beta expression generally fluctuated inversely to the inhibitory activity of LPS, LPS + BaP, and LPS + BaP + Res combinations. Smoke-derived aryl hydrocarbons and bacterial LPS may act additively to inhibit bone formation. The findings may explain, in part, why net periodontal bone loss is greater and bone healing is less successful in smokers than non-smokers with periodontal infections. Reversal of the inhibitory effects in vitro by resveratrol suggests that this phytoalexin should be studied further for its potential therapeutic value, given its aryl hydrocarbon receptor antagonism and apparent anti-inflammatory activity.
Article
Cigarette smoking is associated with a number of adverse health effects, including well-established links to cardiopulmonary disease and several cancers. Some of the other important systemic diseases associated with smoking are the subjects of this article, such as diabetes mellitus and insulin resistance, and thyroid diseases. Also reviewed here is the impact of smoking on male and female infertility, on selected dermatologic conditions, and on gastrointestinal diseases including peptic ulcer and inflammatory bowel diseases.