The effect of smoking on the health status of the supporting tissues around dental implant; a systematic review

Abstract

Background:

Smoking is a well-established risk factor for dental implant failure and peri-implant tissue complications. This systematic review synthesizes evidence on the effects of smoking on the health of supporting tissues around dental implants, including marginal bone loss, soft tissue inflammation, and peri-implant disease.

Methods:
A comprehensive literature search was conducted following PRISMA guidelines across PubMed/MEDLINE, Science Direct, Web of Science, and Cochrane Library (inception to May 2025). Eligible studies included human subjects aged ≥18 years, assessing smoking’s impact on peri-implant health (e.g., probing depth, bleeding on probing, marginal bone loss). Risk of bias was evaluated using the Newcastle-Ottawa Scale for observational studies.

Results:

A total of eight studies were included that include six retrospective cohort and two cross-sectional studies, totaling 1,228 implants. Smokers demonstrated significantly greater marginal bone loss compared to non-smokers, with a clear dose-response relationship observed between smoking frequency and bone loss severity. Soft tissue parameters including plaque index, probing depth, and gingival index were all significantly worse in smokers, with one study reporting 40.3% of smokers showing severe plaque accumulation versus 16.9% in non-smokers. The prevalence of peri-implant inflammation was markedly higher among smokers, reaching 63.2% compared to 39.1% in non-smokers.

Conclusions: 

The evidence consistently indicates that smoking adversely affects peri-implant tissue health, increasing risks of bone loss, inflammation, and peri-implant disease. These findings underscore the importance of preoperative smoking cessation counseling and long-term monitoring for smokers with dental implants to optimize treatment outcomes.