Overview
If you smoke and are considering dental implants, the honest summary from the literature is this: implants can still succeed in smokers, but they fail roughly twice as often as in non-smokers, and the long-term threat of peri-implantitis is meaningfully higher[1]. None of that means an implant is off the table — it means the conversation has to be different.
This guide explains why nicotine and combustion products are so unfriendly to bone healing, what the cessation evidence looks like, and what a reasonable surgical protocol involves for someone who smokes.
Why smoking hurts implant healing
Osseointegration depends on a tightly orchestrated wound-healing response: a stable blood clot, organised vascular ingrowth, and ordered bone deposition along the implant surface. Nicotine constricts peripheral blood vessels and reduces tissue oxygenation. Carbon monoxide displaces oxygen from haemoglobin. Combustion by-products impair neutrophil function and fibroblast activity. Together they slow soft-tissue healing and reduce the density of bone-to-implant contact during the first few months after surgery.
Longer term, smokers carry a higher plaque load on average and mount a more destructive inflammatory response around the implant — the same pattern that drives periodontitis around natural teeth[2][3].
What the survival data actually shows
A 2015 systematic review and meta-analysis (Chrcanovic et al.) pooled 107 studies and reported that smokers experienced implant failure at roughly 2.2 times the rate of non-smokers, with higher post-op infection rates and significantly more marginal bone loss[1]. Failure was concentrated in the first year, but bone loss continued to diverge over longer follow-up. The maxilla (upper jaw) appears more sensitive than the mandible.
Peri-implantitis prevalence is consistently higher in smokers and former smokers across cohort studies, with smoking listed as a major modifiable risk factor in the EFP 2023 clinical practice guideline[4].
Does quitting before surgery help?
Yes, but the evidence on exact timing is mixed. The Bain protocol — stop smoking at least one week before surgery and for eight weeks after — was associated with failure rates comparable to non-smokers in early studies. Quitting altogether is the only intervention that brings long-term peri-implantitis risk back toward baseline. Cutting down or switching to e-cigarettes has not been shown to restore implant healing to non-smoker levels in current evidence.
Practical recommendation: at minimum, plan to stop for two weeks before and eight weeks after each surgical visit (placement, grafting, second-stage uncovering). Use the period as a structured cessation attempt rather than a one-off pause.
What a smoker-aware protocol looks like
- Document smoking history (pack-years, current daily count) before consent.
- Consent includes the elevated failure rate and peri-implantitis risk in writing.
- Prefer two-stage submerged healing in the maxilla over immediate loading where possible.
- Tighter maintenance recall — every 3–4 months for the first 2 years.
- Lower threshold to abandon a borderline immediate-placement plan in favour of socket preservation + delayed placement.
Frequently asked questions
Scientific references
- 1. Chrcanovic BR, Albrektsson T, Wennerberg A. (2015). Smoking and dental implants: A systematic review and meta-analysis. J Dent. 43(5):487-98. View source
- 2. Berglundh T, Armitage G, Araujo MG, et al. (2018). Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 45 Suppl 20:S286-S291. View source
- 3. Derks J, Tomasi C. (2015). Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 42 Suppl 16:S158-71. View source
- 4. Herrera D, Berglundh T, Schwarz F, et al. (EFP Workshop). (2023). Prevention and treatment of peri-implant diseases — The EFP S3 level clinical practice guideline. J Clin Periodontol. 50 Suppl 26:4-76. View source