Smoking – Why Does It Reduce Implant Success?
It is generally well recognized that the skin of smokers appears prematurely aged when compared to nonsmokers. We all recognize higher rates of periodontal disease and lower rates of implant success in smokers. Oral bone and soft tissue grafts in smokers fail at alarming rates.
What is the commonality in these adverse effects of smoking? The reality is that one of the chemical effects of nicotine and other substances in cigarette smoke is vasoconstriction. Nicotine causes vessels, particularly capillaries, to constrict for varying amount of time after each cigarette is smoked. The more frequently one smokes, the less time the capillaries have to recover and in a short period of time, capillaries atrophy and disappear. Thus, the smoker has a reduced blood and oxygen supply throughout all areas of the body when compared to the nonsmoker. With reduced blood supply, they are less able to repair the normal everyday damage sustained from the environment and the activities of daily living. For example, normal trauma to teeth that is generally subclinical and easily repaired at the microcellular level in the smoker is not repaired to the same degree due to a decreased blood supply to the area.
The skin of smokers exposed to sunlight and other oxidative stress is less able to reverse and repair these challenges and, therefore, ages at an accelerated rate when compared to a nonsmoker of similar age and background.
Bone and soft tissue grafts, which in essence are transfers of tissue to a recipient bed in the mouth, are at tremendous risk of failure in the smoker due to a decreased vascular bed to nourish these grafts. If they do not become incorporated, they simply become infected or atrophy.
Finally, dental implants, which depend on bone ingrowth at the microscopic level in order to integrate, fail at higher rates in smokers due to compromised blood supply which then compromises the bone’s ability to grow densely into the implant surface.
Ironically, if smokers can cease smoking for three months prior to these procedures, the majority of the capillary density is reformed and bone, soft tissue and implant success rates rival those of people who have never smoked.
As dental professionals, we have the opportunity to advise our patients as to the specific risks of smoking as it relates to their oral health. By explaining to patients how smoking affects our ability to heal and accelerates our aging, especially as it relates to the oral cavity, we, as dental professionals, can improve not only our patients’ dental implant success rates, but also their overall health.
Doing so may not only add years to their lives, but also add life to their years!
The Palm Beach Center for Oral Surgery and Dental Implants providing quality care to Delray Beach, Boca Raton, Boynton Beach, and Palm Beach County. 561.900.9080 www.PasqualOMS.com