Smoking, Vaping and Their Effect on Dental Implants: What You Need to Know

Dental implants have become a reliable and long-lasting solution for replacing missing teeth. They restore function, protect surrounding bone, and improve confidence in everyday life. However, lifestyle choices—particularly smoking and vaping—can significantly affect how well implants heal and how long they last. At our practice in Worthing, we often receive questions from patients about whether smoking or e-cigarette use impacts implant treatment outcomes.

In this article, we will review how both smoking and vaping affect oral health, explain the risks for implant patients, and outline steps you can take to improve success rates.

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How Dental Implants Heal

A dental implant is a small titanium post surgically placed into the jawbone. Over a period of several months, the bone fuses with the implant surface in a process called osseointegration. For this to succeed, healthy blood flow, bone quality, and gum healing are crucial.

Any factor that reduces oxygen supply, slows healing, or increases the risk of infection can jeopardise implant success. Smoking—and, increasingly, vaping—are two such risk factors.

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Smoking and Dental Implant Failure

Cigarette smoke contains thousands of harmful chemicals, including nicotine, carbon monoxide, and tar. These affect implant healing in several ways:

• Reduced blood flow: Nicotine causes blood vessels to constrict, limiting oxygen delivery to the tissues around the implant. This slows down osseointegration (Bain & Moy, 1993).
• Increased risk of infection: Smoking impairs immune function, making gum tissues more vulnerable to peri-implantitis, a destructive inflammation around implants (Heitz-Mayfield, 2008).
• Bone loss: Long-term smoking is linked to greater marginal bone loss around implants, compromising stability (Hinode et al., 2006).

Studies consistently show that implant failure rates are higher in smokers compared with non-smokers. For example, one review found that smokers are nearly twice as likely to experience implant failure (Chrcanovic et al., 2015).

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What About Vaping?

Vaping is often marketed as a “safer” alternative to smoking. While e-cigarettes contain fewer carcinogens than tobacco, they still deliver nicotine and other substances that may affect implant healing.

• Nicotine in e-liquids: Just like smoking, vaping restricts blood flow to gum tissues. This can delay wound healing after implant surgery.
• Heat and chemicals: Vapourised propylene glycol and glycerine can cause dry mouth, reducing saliva’s protective effect against bacteria (Fraser et al., 2020).
• Inflammatory response: Emerging studies show vaping increases oxidative stress and inflammation in gum tissues, similar to smoking (Cichońska et al., 2019).

Although long-term research is limited, early evidence suggests vaping may still increase the risk of implant complications—though possibly to a lesser degree than smoking.

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Peri-Implantitis: A Major Concern

One of the most significant complications related to smoking and vaping is peri-implantitis. This condition involves inflammation of the gums and bone around the implant, leading to progressive bone loss and potential implant failure.

Both smoking and vaping appear to increase susceptibility by altering the oral microbiome, reducing healing capacity, and impairing the body’s natural defence against bacteria (Heitz-Mayfield & Salvi, 2018). Once peri-implantitis develops, treatment becomes complex and outcomes are less predictable.

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Improving Success Rates

If you are considering dental implants and you smoke or vape, it is important not to lose hope. Many patients in Worthing, Brighton, and across Sussex who smoke still benefit from implants—provided they take certain steps:

1. Quit if possible: Stopping smoking (or vaping) before surgery significantly improves outcomes. Even short-term cessation of 1–2 weeks pre-surgery and up to 8 weeks post-surgery reduces complications (Clarke et al., 2012).
2. Cut down gradually: If quitting altogether is difficult, reducing daily use can help improve blood flow and healing.
3. Optimise oral hygiene: Regular brushing, flossing, and professional cleaning reduce bacterial load around implants.
4. Attend maintenance visits: Implants require regular check-ups and hygiene visits to monitor gum health and prevent peri-implantitis.
5. Consider nicotine replacement: Patches or gum may support healing better than smoking or vaping, as they avoid heat and toxic by-products.

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Our Practice Approach

At the Clinic for Implant & Orthodontic Dentistry in Worthing, we take a personalised approach. Before recommending implants, we carefully review your medical history, smoking or vaping habits, and oral health status.

For patients who smoke or vape, we provide tailored advice on risk reduction, work closely with hygienists to support gum health, and offer regular monitoring after implant placement. With careful planning and maintenance, many patients still achieve excellent long-term outcomes.

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Conclusion

Smoking and vaping both negatively impact dental implant success, mainly by reducing healing capacity and increasing the risk of peri-implantitis. While vaping may be less harmful than traditional smoking, it is not risk-free.

If you are considering implants, the best step you can take is to quit smoking or vaping entirely. If that is not possible, reducing use and committing to excellent oral hygiene and regular check-ups can still improve outcomes.

At our Worthing practice, we are here to help guide you through every step of your implant journey and support you in achieving a healthy, confident smile.

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References

• Bain, C.A. & Moy, P.K. (1993). The association between the failure of dental implants and cigarette smoking. International Journal of Oral and Maxillofacial Implants, 8(6), 609–615.
• Chrcanovic, B.R., Albrektsson, T. & Wennerberg, A. (2015). Smoking and dental implants: A systematic review and meta-analysis. Journal of Dentistry, 43(5), 487–498.
• Cichońska, D. et al. (2019). The impact of e-cigarettes on oral health – a narrative review. Oral Health and Dental Management, 18(1), 1–8.
• Clarke, N.G. et al. (2012). Influence of smoking on oral wound healing: A review. Journal of Dental Research, 91(2), 119–123.
• Fraser, T., McCullough, M. & Gordon, C. (2020). E-cigarettes and oral health: A scoping review. Tobacco Induced Diseases, 18, 89.
• Heitz-Mayfield, L.J.A. (2008). Peri-implant diseases: Diagnosis and risk indicators. Journal of Clinical Periodontology, 35(Suppl 8), 292–304.
• Heitz-Mayfield, L.J.A. & Salvi, G.E. (2018). Peri-implant mucositis and peri-implantitis: A current understanding of their diagnoses and clinical implications. Journal of Periodontology, 89(Suppl 1), S257–S262.
• Hinode, D., Tanabe, S., Yokoyama, M. & Fujisawa, K. (2006). Influence of smoking on osseointegrated implant failure. International Journal of Oral and Maxillofacial Implants, 21(2), 294–299.

Dental implants in patients affected by systemic diseases - By Dr Amir Mostofi -DDS, Dip. (Ortho.), MSc(Implant.)

Dental implants in patients affected by systemic diseases

The exploration of dental implant success among patients burdened by systemic diseases reveals a realm of nuanced considerations, pivotal for optimising patient care and outcomes. Authored by N. Donos and E. Calciolari and published in the British Dental Journal in 2014, this comprehensive review sheds light on the intersection between systemic health conditions and dental implantology, presenting an invaluable resource for dental professionals worldwide.

Systemic diseases, encompassing a wide array of health conditions, often necessitate medications that could influence or complicate the process of dental implant surgery. Understanding the intricate relationship between these systemic conditions and dental implant success is crucial for clinicians, as it aids in the meticulous planning and execution of implant surgeries, ensuring both the safety and well-being of patients. This narrative delves into the evidence surrounding implant survival and success in patients with systemic diseases, offering practical suggestions for clinicians and highlighting areas necessitating further research.

Dental implants represent a cornerstone in the treatment of edentulism, showcasing high survival rates and offering a semblance of natural dentition. The essence of achieving successful implant outcomes lies in judicious patient selection, entailing a thorough medical history evaluation and a comprehensive assessment of the surgical site's complexity. Certain systemic conditions, underscored by varying levels of evidence, have been identified as potential complicating factors or even contraindications to implant surgery. This increasing prevalence of medically compromised individuals seeking dental implants underscores the importance of understanding the impact of systemic diseases and associated medications on both the surgical procedure and the overall treatment outcome.

Among the systemic conditions deemed as absolute contraindications for implant surgery are recent cardiovascular events, recent major surgeries such as valvular prosthesis placement or organ transplants, heightened risk of bleeding, significant immunosuppression, active cancer treatment, and intravenous bisphosphonate therapy. These conditions pose not only a heightened risk of implant failure but also potential grave risks to the patient's overall health.

The review further explores the effect of various systemic diseases on dental implant outcomes, with a focus on bone diseases such as osteoporosis, medication-related osteonecrosis of the jaws (MRONJ), and other less common bone conditions. Osteoporosis, a prevalent bone disease, poses biological plausibility for impaired bone healing around implants, though evidence remains controversial. Antiresorptive medications, particularly bisphosphonates and denosumab, present a risk for MRONJ, influencing implant success rates and necessitating careful patient management.

Diabetes mellitus, characterised by hyperglycemia, has been shown to negatively impact bone metabolism and may impede osseointegration and implant success. The review emphasises the importance of glycaemic control in diabetic patients undergoing implant therapy, alongside the management of other complications associated with diabetes.

Cardiovascular diseases, bleeding disorders, and specific mucosal diseases such as oral lichen planus and ectodermal dysplasia are also scrutinized for their potential impact on dental implant outcomes. The review suggests tailored approaches and precautionary measures for patients with these conditions, aiming to maximise implant success while minimising risks.

The document culminates in general clinical recommendations, underscoring the limited evidence base concerning the effect of systemic diseases on dental implant success. It calls for larger prospective studies to enhance understanding and provide more definitive guidance. Despite a few conditions being labelled as absolute contraindications, the review advises dental professionals to weigh the benefits and risks of implant therapy carefully, engage in interdisciplinary communication, and adopt stringent follow-up regimens for patients with systemic diseases.

In essence, the review by Donos and Calciolari serves as a testament to the complexity of dental implantology within the context of systemic health. It beckons a holistic approach to patient care, emphasising the need for ongoing research, clinical prudence, and a deep understanding of the interplay between systemic diseases and dental implant outcomes.