Original Article

Assessment of Bone Loss Around Dental Implant in Smokers

Arundhati Singh1, Shreedevi Bhoi1, Pravin M Parmar2, Deepak TS3, Abdullah Khalid Almutairi4, Anuj Singh Parihar5,
Vardharajula Venkata Ramaiah6

1
Department of Oral and Objectives: This research was done to assess how much bone is lost around dental

Abstract
Maxillofacial Surgery,
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Hazaribag College of
implants in smokers. Material and Method: There were 80 participants total in
Dental Sciences and the study, 40 of whom were smokers (Group I) and 40 of who were non‑smokers
Hospital, Hazaribag, India, (Group II). By evaluating the patients’ clinical and radiographic data, the marginal
2
Prosthodontics, Dental bone‑level measurements were determined. The acquired information underwent
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 09/08/2023

Surgeon, Class-1, General statistical analysis. Results: Smokers were found to have worse overall clinical
Hospital, Dist-Botad, parameters than non‑smokers (P 0.05). Smokers experience more marginal bone
India, 3Department of Oral
Medicine and Radiology,
loss around implants than non‑smokers do. Conclusion: Smoking has a negative
Subbaiah Institute of impact on the outcome rate of dental implants.
Dental Sciences, Purle,
Shivamogga, Karanataka,
India, 5Department of
Periodontology, People’s
Dental Academy, Bhopal,
Madhya Pradesh, India,
4
Dental Intern, College of
Dentistry in ArRass, Qassim
University, Kingdom of
Saudi Arabia, 6Department of
Dental Hygiene, College of
Applied Health Sciences in
ArRass, Qassim University,
Saudi Arabia
Submitted: 16‑Feb‑2023
Revised: 23-Feb-2023
Accepted: 24‑Feb‑2023
Published: 28-Apr-2023 Keywords: Bone loss, implant, smoking

Introduction first year following placement is required for implant

T he use of dental implants to replace missing
teeth is growing. It has been demonstrated that
implant‑retained prostheses are linked to successful
long‑term results.[1] One of the most popular forms of
treatment is the use of fixed or removable prostheses
supported by dental implants. The stability of the
surrounding bone is thought to be a crucial factor in
determining the likelihood that an implant will survive
over time. Smoking has been found to negatively
impact the success of implant restorations, and the
biological complications that result cause the loss
of the supporting bone. A maximum marginal bone
loss (MBL) of 1 mm around the implant during the
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success.[2]
However, there are limited studies on implant success
with smoking. Hence, the current research was done to
assess the bone loss around dental implant in smokers
compared to non‑smokers.
Address for correspondence: Dr. Shreedevi Bhoi,
Department of Oral and Maxillofacial Surgery, Hazaribag College
of Dental Sciences and Hospital, Hazaribag ‑ 825 301,
Jharkhand, India.
E‑mail: shree_bhoi@yahoo.co.in
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix,
tweak, and build upon the work non‑commercially, as long as the author is credited
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For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

How to cite this article: Singh A, Bhoi S, Parmar PM, Deepak TS,
DOI: 10.4103/jpbs.jpbs_158_23 Almutairi AK, Parihar AS, et al. Assessment of bone loss around dental
implant in smokers. J Pharm Bioall Sci 2023;15:S1208-10.

S1208 © 2023 Journal of Pharmacy and Bioallied Sciences | Published by Wolters Kluwer - Medknow
 Singh, et al.: Bone loss around dental implant in smokers

Materials and Methods
This retrospective research was done in Oral
Surgery department, after obtaining endorsement
from institutional ethics committee and informed
permission from participants. This research was
done after considering the inclusion and exclusion
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with a significance level of P 0.05, the obtained data
were statistically evaluated.
Results
Table 1 indicates increases in mean marginal bone loss
in smokers from 3 months to 6 months period. Table 2

criteria. The study was done from 2016 to 2019 on
total 80 subjects with 40 smokers (Group I) and
40 non‑smokers (Group II) having dental implants. The
questionnaire was collected with relation to demographic
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 09/08/2023
indicates mean marginal bone loss after 6 months, and it
was comparatively lesser than group I. Table 3 indicates
21 implant failure in group I and 3 in group II. Implant
failure increases with longer duration (>10 years) of
smoking habit.

profile and smoking habit (number, duration of habit,

and type of cigarette used).
Discussion
In both groups, every dental implant was put in place
The dental implant success is based on various risk
through a routine surgical procedure. By assessing the
factors such as smoking habit, presence of underlying
bone loss around the distal, mesial, lingual, and buccal
sides of each implant with periapical radiographs, the medical conditions, implant type, and design. We found
outcome of smoking on the success of the implant was that smoking has a more destructive effect on MBL
identified. The space between the widest portion of the around dental implants.
implant and the crestal bone level was calculated on Mumcu et al. evaluated how smoking affected the
the radiographic images. All implants’ marginal bone marginal bone loss around implant‑supported prostheses
attachment at their buccal, lingual, mesial, and distal and came to the conclusion that overall clinical
portions was visually assessed. Using IBM Chicago’s parameters were found to be worse in smokers than
SPSS statistical software version 21.0 and a paired t test in non‑smokers.[2] Alfadda came to the conclusion that
smoking is significantly more likely to result in implant
failure and minor bone loss after conducting a systematic
Table 1: Dental implants in Group I (smoker) patients
with marginal bone loss
review and meta‑analysis of 7 studies.[1] Singh et al.
Location 3 months 6 months deduced from the study that smokers had higher rates of
after implant after implant dental implant failure than non‑smokers.[3] Nazeer et al.
placement placement claimed that smoking generally lowers the success
Maxillary anterior region 2.2±0.21 2.8±0.34 rate of dental implants and that smoking for longer
Maxillary posterior region 2.3±0.54 2.8±0.45 periods of time and more frequently causes more
Mandibular anterior region 2.2±0.23 2.8±0.65 marginal bone loss around dental implants.[4] According
Mandibular posterior region 2.3±0.34 2.9±0.76 to research by Alam et al., smokers experience
greater marginal bone loss than non‑smokers.[5] These
Table 2: Dental implant patients in Group II (non‑smokers) outcomes concur with what we discovered. According
have some bone loss around their implants to Galindo‑Moreno et al., at six month of follow‑up,
Location 3 months 6 months 0.5 mm of MBL is stated as a typical and objective
after implant after implant criterion of success in implant dentistry.[6] Arora et al.
placement placement came to the conclusion that long‑term and frequent
Maxillary anterior region 1±0.43 1.1±0.68 smoking increased the risk of implant failure due to bone
Maxillary posterior region 1.3±0.34 1.4±0.65
resorption.[7] DeLuca and Zarb came to the conclusion
Mandibular anterior region 1.3±0.57 1.6±0.87
that smoking should not be a complete disqualifier for
Mandibular posterior region 1.5±0.67 1.6±0.83
implant therapy; but long‑term heavy smokers should be
made aware that they have a marginally increased late
Table 3: Failure rate in both groups implant failure risk.[8]
Implant Failure rate Group I Group II P
Number of failure 21 3 0.001 Smoking has been found to have an adverse effect
Mean bone loss at 3 months 2.2±0.34 1.1±0.46 on implant survival due to slowed wound healing.
Mean bone loss at 6 months 2.8±0.44 1.3±075 Although the precise mechanisms by which smoking
Mobility of implant with 5 0 affects the osseointegration process are still unknown,
smoking period (<10 years) it is generally accepted that the accumulation of fibrous
Mobility of implant with 16 0 tissue at the bone–implant interface is what causes
smoking period (>10 years) osseointegration failures. According to clinical studies,

Journal of Pharmacy and Bioallied Sciences ¦ Volume 15 ¦ Supplement 2 ¦ July 2023 S1209
 Singh, et al.: Bone loss around dental implant in smokers

during the initial healing period prior to prosthetics Financial support and sponsorship
insertion, smokers exhibit a 1.69 times higher incidence Nil.
of implant loosening than non‑smokers.[2]
Conflicts of interest
Because of the tobacco’s high nicotine content and There are no conflicts of interest.
high level of permeability through the weak gingival
epithelium, the osteoblastic activity directly beneath the References
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epithelium is modulated. Therefore, the compromised
epithelial barrier is primarily responsible for the higher
MBL found in smoking groups.[2] By displacing oxygen
from hemoglobin, carbon monoxide from cigarette
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 09/08/2023
1. Alfadda SA. Current evidence on dental implants outcomes in
smokers and nonsmokers: A systematic review and meta‑analysis.
J Oral Implantol 2018;44:390‑9.
2. Mumcu E, Beklen A. The effect of smoking on the marginal
bone loss around implant‑supported prostheses. Tob Induc Dis

smoking reduces oxygen tension in tissues. Nicotine 2019;17:43.

has been shown to negatively affect bone regeneration,
and it has been observed in high concentrations in
saliva (96 ng mL‑1 to 1.6 mg mL‑1) and crevicular
fluid (5961 ng mL‑1). Additionally, it has been found
that smokers have significantly lower polymorphonuclear
neutrophil viability and opsonized Candida albicans
phagocytosis rates than non‑smokers.[1]
From the present study, it has been found that smoking
has higher bone loss around dental implants compared
to non‑smokers. Further studies are needed to verify the
findings.
Conclusion
Smokers experience more marginal bone loss around
implants than non‑smokers do. Smoking has a negative
impact on the success rate of dental implants. Smoking
for longer periods of time and more frequently can
result in more severe marginal bone loss around dental
implants.
3. Singh P, Ahuja S, Gattani D, Sharma S, Dorkar PS, Sharma H.
Evaluation of dental implants failures in smokers and healthy
subjects. European Journal of Molecular and Clinical Medicine
2020;7:6406‑11.
4. Nazeer J, Singh R, Suri P, Mouneshkumar CD, Bhardwaj S,
Iqubal MA, et al. Evaluation of marginal bone loss around dental
implants in cigarette smokers and nonsmokers. A comparative
study. J Family Med Prim Care 2020;9:729‑34.
5. Alam S, Balehonnur P, Joshi S, Rahman RA,
Thind Gurinder Bir Singh, Khilji I. Evaluation of crestal loss
around dental implants in cigarette smokers bone. Int J Cur Res
Rev 2021;13:S124‑8.
6. Galindo‑Moreno P, Catena A, Pérez‑Sayáns M,
Fernández‑Barbero JE, O’Valle F, Padial‑Molina M. Early
marginal bone loss around dental implants to define success in
implant dentistry: A retrospective study. Clin Implant Dent Relat
Res 2022;24:630‑42.
7. Arora A, Reddy MM, Mhatre S, Bajaj A, Gopinath PV, Arvind P.
Comparative evaluation of effect of smoking on survival of
dental implant. J Int Oral Health 2017;9:24‑7
8. DeLuca S, Zarb G. The effect of smoking on osseointegrated
dental implants. Part II: Peri‑implant bone loss. Int J Prosthodont
2006;19:560‑6.

S1210 Journal of Pharmacy and Bioallied Sciences ¦ Volume 15 ¦ Supplement 2 ¦ July 2023