The effect of smoking on the marginal bone loss around implant-supported prostheses

Implantology has led to several changes in the planning process involved in the application of dental prostheses to diminish bone level changes along the margins of dental implants. However, the relationship between smoking and marginal bone loss around dental implants, supporting both fixed and removable prostheses has not been investigated. We hypothesize that the design of different prostheses alter the effects of smoking, which consequently affects the amount of supporting alveolar bone.

In this study, we included 137 implants in the 'implant-supported fixed prostheses' (ISFP) group (31 smokers, 106 non-smokers) and 94 implants (21 smokers, 73 non-smokers) in the 'implant-supported removable prostheses' (ISRP) group. The corresponding patients were examined in routine recall sessions conducted at 6, 12 and 24 months after the placement of the dental prostheses. The recorded clinical periodontal parameters were the presence/ absence of a plaque index, bleeding index, and the probing depths. These periodontal parameters were assessed in conjunction with marginal bone level measurements. Comparative bone level measurements were obtained from radiographical images at ×20 magnification using the CorelDraw 11.0 software program. Statistical analysis was performed using the SPSS Statistical Software version 21.0.

The overall clinical parameters were found to be poorer in smokers than in non-smokers (p<0.05). In all the groups, time-dependent bone loss was observed. However, among the patients with ISRPs, smokers were associated with significantly greater marginal bone loss compared to patients with ISFPs (p<0.05).

In smokers with dental ISRPs, the marginal bone loss rates are likely to reach critical levels. Therefore, after the placement of prostheses, strict recall periods with a dental professional should be observed, and their guidance should be implemented in order to monitor the health of the bones around the implants.