Smoking and dental implants: the impact on healing and treatment success

Smoking can interfere with healing after dental implant placement, increasing the risk of complications and failure of osseointegration. However, smoking is not always an absolute contraindication to dental implant treatment.

Smoking affects blood circulation and tissue oxygenation, slowing down gum healing after dental implant placement. It increases the risk of infections, peri-implantitis, bone loss, and failure of osseointegration, reducing the chances of long-term treatment success.

In many cases, following their dentist's recommendation, patients significantly reduce the number of cigarettes they smoke around the time of implant surgery, while some quit smoking altogether, taking an important step toward a healthier lifestyle.

In short:

• Smoking is not always an absolute contraindication for dental implants, but it does increase the risk of complications.
• Nicotine and other substances in cigarette smoke can affect blood circulation, tissue healing and osseointegration.
• Giving up smoking is recommended both before and after the procedure, and the period of abstinence should be agreed with your dentist.
• Smoking can increase the risk of bone loss and peri-implantitis, even after healing is complete.
• Regular check-ups and proper oral hygiene are important for maintaining the health of your implants. 

Yes, dental implant treatment can also be carried out on patients who smoke; however, it is important to treat any periodontal conditions before the implants are placed and to maintain rigorous oral hygiene, both before and, in particular, after the procedure.

Smoking affects tissue blood supply, slows down healing and can compromise the osseointegration of the implant. Therefore, the more cigarettes a patient smokes per day and the longer their history of smoking, the greater the risk of complications associated with dental implants.

Giving up smoking is one of the measures that may be recommended as part of the preparation for dental implant treatment, alongside an assessment of oral health and the treatment of any periodontal conditions.

The success of dental implant treatment depends largely on the health of the gums, the quantity and quality of the available bone, and the patient’s general state of health. For example, uncontrolled diabetes and other conditions that affect healing can increase the risk of complications, particularly when combined with smoking.

By knowing the number of cigarettes smoked daily and the patient’s medical history, the dentist can assess the risks more accurately, adapt the treatment plan and recommend measures to increase the chances of success, even before the actual procedure takes place. 

Nicotine causes vasoconstriction and can reduce the supply of oxygen and nutrients to oral tissues, impairing healing processes. Carbon monoxide reduces tissue oxygenation, whilst the toxic substances in cigarette smoke promote inflammation, oxidative stress and cell damage. 

Delayed healing following implant placement

Insufficient oxygenation can affect the formation of new blood vessels, tissue regeneration and the osseointegration process, increasing the risk of delayed healing, infections and dental implant failure.

Toxic substances in cigarette smoke affect the activity of the cells responsible for tissue regeneration and collagen formation, delaying wound closure and scarring.

The risk of poor osseointegration and implant loss

Osseointegration is the biological process by which a dental implant integrates into the maxillary or mandibular bone, creating a direct and stable connection between the implant surface and the bone tissue.

Smoking can affect the stability of a dental implant by reducing blood flow and tissue oxygenation, thereby slowing down the process of bone regeneration and osseointegration.

Nicotine and other toxic substances in cigarette smoke have a negative effect on the activity of the cells responsible for bone formation and promote inflammation of the tissues surrounding the implant.

Early dental implant failure occurs before osseointegration has taken place, usually within the first few weeks or months after placement.

Late complications occur after the implant has osseointegrated and become functional, sometimes several years after treatment.

Bone loss and the risk of peri-implantitis

Over time, persistent inflammation can lead to progressive resorption of the bone surrounding the implant and the development of peri-implantitis, an inflammatory condition associated with bacterial biofilm, which can compromise the stability of the implant and, in advanced cases, lead to its loss.

Peri-implantitis is a complication that can occur following implant placement, caused in particular by the accumulation of bacterial plaque around the implant neck. 

Smoking is a major risk factor for peri-implantitis and its associated complications, an inflammatory condition that can lead to progressive bone loss around the implant. 

To reduce the risk of complications and to promote osseointegration of the dental implant, it is recommended that you stop smoking at least 2–4 weeks before the procedure and avoid smoking for at least 7–14 days after the implant has been placed.

How long before dental implant surgery is it recommended to stop smoking?

It is recommended that you stop smoking 2–4 weeks before dental implant treatment to improve blood circulation, tissue oxygenation and the body’s natural healing ability.

The longer the period of abstinence, the lower the risk of complications.

How many days should you avoid smoking after a dental implant?

After dental implant placement, it is recommended that you avoid smoking completely for at least the first 7–14 days, ideally for as long as possible, including during the osseointegration period.

The risks associated with smoking during this period include persistent inflammation, delayed healing, the surgical wound opening up (dehiscence) and an increased risk of post-operative infections.

Adherence to post-operative instructions is essential for proper tissue healing and the success of dental implant treatment. The patient must avoid smoking, maintain rigorous yet gentle oral hygiene in the operated area, follow the prescribed medication regimen and avoid strenuous physical activity in the first few days following the procedure.

It is also important to avoid hard or hot foods in the immediate post-operative period and to attend the check-ups scheduled by your dentist.

Can you start smoking again once the implant has healed?

Yes, but it is recommended that you give up this habit for as long as possible.

The gum usually heals within the first 1–2 weeks after the procedure, which involves the closure of the surgical wound and the regeneration of the soft tissues surrounding the implant.

Osseointegration of the implant is a longer process, generally taking between 2 and 6 months, and involves the formation of a stable connection between the implant and the surrounding bone.

The risks associated with smoking do not disappear in the first few weeks after the dental implant is placed, as osseointegration continues for several months, even if the gum appears to have healed completely.

In the long term, patients who give up smoking are more likely to maintain healthy and functional dental implants, reducing the risk of complications and the need for further treatment. 

Smoking a single cigarette after the placement of a dental implant does not automatically mean that the treatment will fail or that the implant will be lost. Osseointegration is a complex biological process influenced by several factors, such as bone quality, primary stability of the implant, general health and oral hygiene.

If you have started smoking again after having a dental implant fitted, it is recommended that you stop smoking as soon as possible to minimise the negative effects on healing and osseointegration.

It is important to discuss this with your dentist without waiting for complications to arise, as they can assess how the healing is progressing, identify any potential problems at an early stage, and tailor their recommendations and the frequency of check-ups according to your risk factors. 

Traditional cigarettes burn tobacco, producing smoke that contains nicotine, carbon monoxide and numerous toxic substances. E-cigarettes heat a liquid, generating an aerosol that may contain nicotine and other irritants, whilst other devices heat tobacco without conventional combustion.

Nicotine can affect blood circulation and healing processes, and aerosols can have a negative impact on the health of peri-implant tissues.

At present, the evidence regarding the long-term effects of these devices on implants is more limited than that relating to conventional smoking. Consequently, neither e-cigarettes nor tobacco heating devices can be considered safe alternatives during the healing and osseointegration phases of dental implants. 

Cut down on smoking as much as possible before and after your dental implant treatment.

Before implant placement

Before any dental implant treatment, the dentist carries out a clinical examination and a cone-beam computed tomography (CBCT) scan to accurately determine the ideal site for implant placement.

During the consultation, the patient is required to inform the dentist about their smoking habits and any risk factors of which they are aware at that time.

Before dental implant treatment, the patient’s periodontal condition must be stabilised, which means that any periodontal conditions must be treated.

A plan to give up smoking is drawn up together with the dentist, on a case-by-case basis.

After implant placement

It is recommended to avoid smoking, including e-cigarettes and tobacco heating devices, as nicotine and other inhaled substances can impair the healing process.

The patient should also maintain good oral hygiene, follow the prescribed treatment, avoid strenuous physical activity in the first few days, and attend the follow-up appointments arranged by the dentist.

For the first 24 hours, it is recommended to avoid brushing directly over the surgical site and vigorous rinsing. Thereafter, oral hygiene can be gradually resumed, using a soft-bristled toothbrush and following the dentist’s instructions. Antiseptic mouthwashes, such as those containing chlorhexidine, may be used when recommended by the dentist.

Avoiding smoking is essential to promote healing and reduce the risk of complications. At the same time, the patient should monitor the progress of the operated area.

Mild discomfort, localised swelling and minor bleeding may be normal in the first few days.

Scheduled follow-up appointments are very important, as they allow the progress of post-operative healing to be monitored by a doctor. 

To keep dental implants healthy and functional for as long as possible, giving up smoking for good, combined with rigorous oral hygiene and regular dental check-ups, is the best preventive strategy.

If patients are unable to give up smoking, it is very important that they attend professional dental cleanings and regular check-ups.

Patients must use dental floss, a mouthwash and brush their teeth twice a day, without fail. They must attend professional cleanings and check-ups every six months.

During dental check-ups, the dentist assesses the condition of the gums, the presence of inflammation, bleeding on probing and the depth of peri-implant pockets. Furthermore, X-rays taken when indicated help to identify any changes in the bone level around the implants.

Signs that may indicate a problem include redness and swelling of the gums around the implant, bleeding when brushing, localised sensitivity, bad breath or the presence of pus-like discharge. 

At DENT ESTET, dental implant treatment begins with an individual assessment of the patient to identify factors that may influence healing, osseointegration and the long-term success of the treatment.

During the consultation, the dentist assesses the patient’s general health, medical history, oral hygiene habits and risk factors, such as smoking, diabetes or a history of periodontal disease.

Clinical assessment and imaging studies enable an evaluation of the quality and quantity of available bone, as well as the health of the oral tissues.

Digital planning using cone-beam computed tomography (CBCT) and intraoral scanning enables the position, angulation and dimensions of dental implants to be determined, taking into account both the patient’s anatomical characteristics and the future prosthetic restoration.

Collaboration between the implantologist, surgeon and periodontist enables a comprehensive assessment of oral health, the identification of any gum or bone problems, and the development of a treatment strategy tailored to each patient.

It is very important for the patient to attend regular check-ups so that the healing process can be monitored.