ZWETCHKENBAUM,SAMUEL
UNIVERSITY OF MICHIGAN


(REFERENCE 1 OF 5)
95367626

De Bruyn H Collaert B
The effect of smoking on early implant failure.

In: Clin Oral Implants Res (1994 Dec) 5(4):260-4
CLINICAL ORAL IMPLANTS RESEARCH

This retrospective study describes the effect of smoking on initial
fixture failure before functional loading with fixed prosthetic
restorations. Of 208 installed Br~anemark fixtures in the mandible,
only 1 failed (0.5%), and no detrimental effect of smoking on fixture
survival could be detected. In the maxilla, 10/244 fixtures failed
(4%); 7/78 fixtures failed in smokers and 3/166 in nonsmokers. The
failure rate before loading was 9% in smokers versus 1% in nonsmokers
and was statistically significant, despite the fact that bone quality
in both groups was comparable. Failed fixtures occurred in 31% of the
smokers, despite often excellent bone quality, long fixture length or
good initial stability. Only 4% of the nonsmokers had failures, in
most cases related to poor bone quality. It is concluded that smoking
is a significant although not the only important factor in the
failure of implants prior to functional loading. Prospective studies
are needed to assess the risk of implant failure in conjunction with
smoking. In the mean time, patients should be informed of the adverse
effect of smoking.

Institutional address:
Center for Periodontology & Implantology
Brussels
Belgium.


*****COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY*****

(REFERENCE 2 OF 5)
95300460

Oikarinen K Raustia AM Hartikainen M
General and local contraindications for endosseal implants--an
epidemiological panoramic radiograph study in 65-year-old subjects.

In: Community Dent Oral Epidemiol (1995 Apr) 23(2):114-8
COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY

In order to evaluate general and local contraindications for
implantation for 65-yr-old subjects from a medium-sized Finnish city,
431 such persons were examined anamnestically and by means of
panoramic radiographs. The population represents 61% of the total age
group in the city (born in 1923). It was shown that several degrees
of cardiac problems and increased blood pressure followed by
pulmonary diseases and diabetes were the most commonly encountered
relative contraindications for implantation. Eleven percent of the
patients said that they smoked regularly and the bone quality was
estimated to be less suitable for implantation in 21% of the cases.
Implantation was evaluated according to the Bonefit system (implant
lengths between 6 and 16 mm) in 10 regions in the maxilla and 6
regions in the mandible and was shown to be possible in 38% of the
regions in the partially edentulous maxillae and 50% of those in the
partially edentulous mandibles, the corresponding figures for the
edentulous jaws were 55% in the maxilla and 61% in the mandible.

Institutional address:
Department of Oral and Maxillofacial Surgery
University of Oulu
Finland.


*****IMPLANT DENTISTRY*****

(REFERENCE 3 OF 5)
95268411

Gorman LM Lambert PM Morris HF Ochi S Winkler S
The effect of smoking on implant survival at second-stage surgery:
DICRG Interim Report No. 5. Dental Implant CLinical Research Group.

In: Implant Dent (1994 Fall) 3(3):165-8
IMPLANT DENTISTRY

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.



*****INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS*****

(REFERENCE 4 OF 5)
94237565

Bain CA Moy PK
The association between the failure of dental implants and cigarette
smoking.

In: Int J Oral Maxillofac Implants (1993) 8(6):609-15
INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS

This paper reviews the outcome of 2,194 Br~anemark implants placed in
540 patients by one of the authors over a 6-year period. The overall
failure rate of 5.92% is consistent with other studies; however, when
patients were subdivided into smokers and nonsmokers, it was found
that a significantly greater percentage of failures occurred in
smokers (11.28%) than in nonsmokers (4.76%) (P < .001). These
differences were significant for all areas except the posterior
mandible. While failure rates decreased with increasing implant
length, failure rates for each implant length were consistently
higher in smokers than in nonsmokers. The possible mechanisms of
failure in smokers are discussed, and a protocol for cessation of
smoking around the time of surgery is proposed.

*****JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY*****

(REFERENCE 5 OF 5)
92177127

Jones JK Triplett RG
The relationship of cigarette smoking to impaired intraoral wound
healing: a review of evidence and implications for patient care.

In: J Oral Maxillofac Surg (1992 Mar) 50(3):237-9; discussion 239-40
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY

Cigarette smoking has long been suspected to adversely effect wound
healing. Review of our experiences with impaired wound healing in
patients undergoing intraoral bone grafting and simultaneous implant
placement implicated smoking as a potentially significant risk
factor. Fifteen consecutive adult patients (5 smokers and 10
nonsmokers) who underwent intraoral bone grafting with simultaneous
implant placement were retrospectively reviewed. Five of 15 patients
experienced impaired wound healing defined as loss of bone and/or
implants. Four of these five (80%) admitted to smoking in the
perioperative period. One of 10 nonsmokers experienced problematic
healing (10%). Although other factors may have played a role,
cigarette smoking is a potentially controllable risk factor strongly
associated with problem wounds in this series of patients. Evidence
implicating smoking as a risk factor is presented and discussed.