Association between Marginal Bone Loss around Osseointegrated Mandibular Implants and Smoking Habits: A 10-year Follow-up Study

Abstract

While many factors are conceivable, occlusal loading and plaque-induced inflammation are frequently stated as the most important ones negatively affecting the prognosis of oral implants. Currently, little is known about the relative importance of such factors. The aim of this study was to analyze the influence of smoking and other possibly relevant factors on bone loss around mandibular implants. The participants were 45 edentulous patients, 21 smokers and 24 non-smokers, who were followed for a 10-year period after treatment with a fixed implant-supported prosthesis in the mandible. The peri-implant bone level was measured on intraoral radiographs, information about smoking habits was based on a careful interview, and oral hygiene was evaluated from clinical registration of plaque accumulation. Besides standard statistical methods, multiple linear regression models were constructed for estimation of the relative influence of some factors on peri-implant bone loss. The long-term results of the implant treatment were good, and only three implants (1%) were lost. The mean marginal bone loss around the mandibular implants was very small, about 1 mm for the entire 10-year period. It was greater in smokers than in non-smokers and correlated to the amount of cigarette consumption. Smokers with poor oral hygiene showed greater marginal bone loss around the mandibular implants than those with good oral hygiene. Oral hygiene did not significantly affect bone loss in non-smokers. Multivariate analyses showed that smoking was the most important factor among those analyzed for association with peri-implant bone loss. The separate models for smokers and non-smokers revealed that oral hygiene had a greater impact on peri-implant bone loss among smokers than among non-smokers. This study showed that smoking was the most important factor affecting the rate of peri-implant bone loss, and that oral hygiene also had an influence, especially in smokers, while other factors, e.g., those associated with occlusal loading, were of minor importance. These results indicate that smoking habits should be included in analyses of implant survival and peri-implant bone loss.

Keywords

bite force cigarette smoking dental implants occlusal loading oral hygiene.

Get full access to this article

View all access options for this article.

References

Adell R. , Lekholm U. , Branemark P-I. (1985). Surgical procedures. In: Tissue-integrated prostheses. Osseointegration in clinical dentistry. Branemark P-I , Zarb GA , Albrektsson T , editors. Chicago: Quintessence, pp. 211-232.

Adell R. , Lekholm U. , Rockler B. , Branemark P-I. , Lindhe J. , Eriksson B. , et al. (1986). Marginal tissue reactions at osseointegrated titanium fixtures. A 3-year longitudinal prospective study. Int j J Oral Maxillofac Surg 15:39-52.

Albrektsson T. , Zarb GA , Worthington P. , Ericsson AR (1986). The long-term efficacy of currently used dental implants: A review and proposed criteria for success. Int J Oral Maxillofac Implants 1:11-25.

Arno A. , Schei O. , Lovdal A. , Waerhaug J. (1959). Alveolar bone loss as a function of tobacco consumption . Acta Odontol Scand 17:3-10.

Bain CA , Moy PK (1993). The association between the failure of dental implants and cigarette smoking. Int J Oral Maxillofac Implants 8:609-615.

Bergstrom J. , Eliasson S. (1987). Cigarette smoking and alveolar bone height in subjects with a high standard of oral hygiene. J Clin Periodontol 14:466-469.

Bolin A. , Lavstedt S. , Frithiof L. , Henriksson CO (1987). Proximal alveolar bone loss in a longitudinal radiographic investigation: IV. Smoking and some other factors influencing the progress in individuals with at least 20 remaining teeth. Gerodontics 3:43-46.

Bolin A. , Eklund G. , Frithiof L. , Lavstedt S. (1993). The effect of changed smoking habits on marginal bone loss. Swed Dent 17:211-216.

Branemark P-I (1983). Osseointegration and its experimental background . J Prosthet Dent 50:399-410.

10.

Brunski JB , Skalak R. (1992). Biomechanical considerations. In: Advanced osseointegration surgery: Applications in the maxillo-facial region . Worthington P , Branemark P-I , editors. Chicago: Quintessence Publishing Co., pp. 15-39.

11.

Carlsson GE (1996). Factors influencing bone resorption around osseointegrated implants in a long-term perspective. Proceedings of the 2nd World Congress of Osseointegration, Oct 3-6,1996 , Rome, pp. 42-47.

12.

Carlsson GE , Lindquist LW (1994). Ten year longitudinal study on masticatory function in edentulous patients treated with fixed complete dentures on osseointegrated implants. Int J Prosthodont 5:448-453.

13.

De Bruyn H. , Collaert B. (1994). The effect of smoking on early implant failure . Clin Oral Impl Res 5:260-264.

14.

Friberg B. , Jemt T. , Lekholm U. (1991). Early failures in 4,641 consecutively placed Branemark dental implants: A study from stage 1 surgery to the connection of completed prostheses. Int j Oral Maxillofac Implants 6:142-146.

15.

Gorman LM , Lambert PM , Morris HF , Ochi S. , Winkler S. (1994). The effect of smoking on implant survival at second-stage surgery. Implant Dent 3:165-168.

16.

Haber J. (1994). Smoking is a major risk factor for periodontitis . Curr Opin Periodontol 12-18.

17.

Haber J. , Wattles J. , Crowley M. , Mandell R. , Joshipura K. , Kent RL ( 1993). Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol 64:16-23.

18.

Henry PJ (1995). Implant hardware-Science or commodity development ? J Dent Res 74:301-302.

19.

Hollender L. , Rockler B. (1980). Radiographic evaluation of osseointegrated implants of the jaws. Dento-Maxillo-Fac Radiol 9:91-95.

20.

Jemt T. ( 1994). Fixed implant-supported prosthesis in the edentulous maxilla. Clin Oral Impl Res 5:142-147.

21.

Jemt T. , Lekholm U. , Adell R. (1989). Osseointegrated implants in the treatment of partially edentulous patients: A preliminary study on 876 consecutively placed fixtures . Int j Oral Maxillofac Implants 4:211-217.

22.

Lekholm U. , Adell R. , Lindhe J. , Branemark P-I. , Eriksson B. , Rockler B. , et al. (1986). Marginal tissue reactions at osseointegrated titanium fixtures. A cross-sectional retrospective study. Int j Oral Maxillofac Surg 15:53-61.

23.

Leonhardt A. (1996). Studies on bacterial relation to titanium (dissertation) . Goteborg, Sweden: Goteborg University .

24.

Lindhe J. , Berglundh T. , Ericsson I. , Liljenberg B. , Marinello C. (1992). Experimental breakdown of peri-implant and periodontal tissues. A study in the beagle dog. Clin Oral Impl Res 3:9-16.

25.

Lindquist LW (1987). Prosthetic rehabilitation of the edentulous mandible. A longitudinal study of treatment with tissue-integrated fixed prostheses . Swed Dent J Suppl 48:1-39.

26.

Lindquist LW , Carlsson GE (1985). Long-term effects on chewing with mandibular fixed prostheses on osseointegrated implants. Acta Odontol Scand 43:39-45.

27.

Lindquist LW , Carlsson GE , Glantz P. -O (1987). Rehabilitation of the edentulous mandible with a tissue-integrated fixed prosthesis. A six-year longitudinal study. Quintessence Int 18:89-96.

28.

Lindquist LW , Rockier B. , Carlsson GE (1988). Bone resorption around fixtures in edentulous patients treated with mandibular fixed tissue-integrated prostheses. J Prosthet Dent 59:59-63.

29.

Lindquist LW , Carlsson GE , Jemt T. ( 1996). A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clin Oral Impl Res 7:329-336.

30.

Meechan JG , Macgregor ID , Rogers SN , Hobson RS , Bate JP , Dennison M. (1988). The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket. Br J Oral Maxillofac Surg 26:402-409.

31.

Mosely LH , Finseth F. , Goody M. (1978). Nicotine and its effect on wound healing. Plast Reconstr Surg 61:570-575.

32.

Osterberg T. , Mellstrom D. (1986). Tobacco smoking: A major risk factor for loss of teeth in three 70-year-old cohorts. Community Dent Oral Epidemiol 14:367-370.

33.

Preber H. , Bergstrom J. (1990). Effect of cigarette smoking on periodontal healing following surgical therapy. J Clin Periodontol 17:324-328.

34.

Quirynen M. (1993). Tissue response to loading and microbiota. In: Osseointegration in oral rehabilitation. An introductory textbook . Naert I , van Steenberghe D , Worthington P , editors. London: Quintessence Publ. Co. , pp. 171-180.

35.

Quirynen M. , Naert I. , van Steenberghe D. , Schepers E. , Calberson L. , Theuniers G. , et al. (1991). The cumulative failure rate of the Branemark system in the overdenture, the fixed partial, and the fixed full prostheses design: A prospective study on 1273 fixtures. J Head Neck Pathol 10:43-53.

36.

Quirynen M. , Naert I. , van Steenberghe D. (1992). Fixture design and overload influenced marginal bone loss and fixture success in the Branemark system. Clin Oral Implants Res 3:104-111.

37.

Rangert B. , Jemt T. , Jorneus L. (1989). Forces and moments on Branemark implants. Int J Oral Maxillofac Implants 4:241-247.

38.

Schnitman PA , Schulman LB (1979). Recommendations of the consensus development conference on dental implants. J Am Dent Assoc 98:373-377.

39.

Skalak R. (1983). Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent 49:843-848.

40.

Strid K-G. (1985). Radiographic results. In: Tissue-integrated prostheses. Osseointegration in clinical dentistry. Branemark P-I , Zarb GA , Albrektsson T , editors. Chicago: Quintessence Publ. Co., Inc., pp. 317-327.

41.

Thomson MR , Garito ML , Brown FH (1993). The role of smoking in periodontal diseases: A review of the literature. J Western Soc Periodontol, Periodont Abstr 41:5-9.

42.

US Department of Health and Human Services ( 1989). Reducing the health consequences of smoking: A report of the Surgeon General. US Public Health Service, Office on Smoking and Health. DHHS Publication No. (PHS) 81-50156, p. 269.

43.

Wennerberg A. (1996). On surface roughness and implant incorporation (dissertation). Goteborg, Sweden: Goteborg University.

44.

Weyant RJ (1994). Characteristics associated with the loss and peri-implant tissue health of endosseous dental implants. Int J Oral Maxillofac Implants 9:95-102.

45.

Zarb GA , Schmitt A. (1990). The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study. Part II: The prosthetic results. J Prosthet Dent 64:53-61.