Healing in smokers versus nonsmokers: survival rates for sinus floor augmentation with simultaneous implant placement

Evidence suggests that smoking is detrimental to the survival of dental implants placed in grafted maxillary sinuses. Studies have shown that improving bone quantity and quality, using rough-surfaced implants, and practicing good oral hygiene may improve outcomes. In this prospective study, the long-term survival rates of implants placed simultaneously with sinus grafting in smokers and nonsmokers were compared.

Implants with roughened surfaces were immediately placed into maxillary sinus grafts in patients with 1 to 7 mm of residual bone. A total of 2132 simultaneous implants were placed into the grafted sinuses of 226 smokers (627 implants) and 505 nonsmokers (1505 implants). A majority of the patients received a composite graft consisting of 50% autogenous bone. In both smokers and nonsmokers, approximately two thirds of the implants had microtextured surfaces; the remainder had hydroxyapatite-coated surfaces. The implants were restored and monitored during clinical follow-up for up to 9 years.

Cumulative survival of implants at 9 years was 97.9%. There were no statistically significant differences in implant failure rates between smokers and nonsmokers.

Implant survival was believed to depend on the following aspects of the technique used: creation of a large buccal window to allow access to a large recipient site; use of composite grafts consisting of at least 50% autogenous bone; meticulous bone condensation; placement of long implants (i.e., 15 mm); use of implants with hydroxyapatite-coated or microtextured surfaces; use of a membrane to cover the graft and implants; antibiotic use and strict oral hygiene; use of interim implants and restricted use of dentures; and adherence to a smoking cessation protocol.