Smoking in relation to early dental implant failure: A systematic review and meta-analysis

Objective: To assess the association between smoking and early dental implant failure by conducting a systematic review and meta-analysis of observational studies.

Data sources: PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched for reports of relevant studies addressing the relationship between smoking and early dental implant failure published between database inception and June 2024.

Study selection: Thirty-two observational clinical studies published between 1994 and 2024 were included, with a total of 59,246 implants at implant level and 14,115 patients at individual level. At implant level, a meta-analysis of 21 included cohort studies showed that smoking was associated with increased risk of early dental implant failure compared with non-smoking (odds ratio [OR], 2.59; 95 % confidence interval [CI], 2.08-3.23). Three included studies reported that smoking was associated with higher maxillary early dental implant failure risk (OR, 5.90; 95 %CI, 2.38-14.66) than that of mandible (OR, 3.76; 95 %CI, 1.19-11.87). At individual level, meta-analysis of thirty cohort studies indicated that risk of early implant failure in smokers was 100 % higher than in non-smokers (OR, 2.00; 95 %CI, 1.43-2.80). Three case-control studies found that risk of early implant failure of smokers was 59 % higher than that of non-smokers (OR, 1.59; 95 %CI, 1.28-1.97).

Conclusions: Smoking was significantly associated with early dental implant failure, particularly at the maxillary location, at both implant and individual level. These findings suggest smoking cessation is a crucial factor in reducing risk of early dental implant failure.

Clinical significance: There is uncertainty about the extent to which smoking influences early dental implant failure, our meta-analysis of findings emphasize smoking was significantly associated with early dental implant failure, particularly at the maxillary location.