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 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 86-90

Comparison of Hard and Soft Tissues Around Dental Implants in Smokers and Non-smokers


1 Dental Implants Research Center, Department of Dental Prosthodontics, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran, Iran
3 Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission11-Feb-2020
Date of Decision27-Feb-2020
Date of Acceptance07-May-2020
Date of Web Publication23-Jul-2020

Correspondence Address:
Seyedmilad Salmani
Dental Implants Research Center, Department of Dental Prosthodontics, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_16_20

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  Abstract 


Introduction: Previous studies have shown that smoking has a significant impact on the success of dental implants. Therefore, the present study was aimed to compare the health of soft and hard tissues surrounding dental implants in smokers and non-smokers in Isfahan. Materials and Methods: The population of this cross-sectional study included 30 smokers and 30 non-smoker patients who received dental implant treatment. The health of soft tissue around the dental implant (by probing the depth index), soft tissue health (with the gingivitis index), bleeding on probe (BOP), plaque index and the health of hard tissue (bone loss) of two groups of smokers and non-smokers were studied and compared. The data were collected and entered into SPSS version 24 and were analyzed using chi-square, Mann Whitney test, and t-test. The analyses were performed at a significant level of P < 0.05. Results: The mean value of the gingival health index in the smokers and non-smokers was 2.17 ± 0.63 and 1.77 ± 0.87, respectively (P < 0.001), the mean of PD index in the smokers and non-smokers was 2.83 ± 0.73 and 7.2 ± 0.7 mm, respectively (P = 0.31). Of the 72 dental implants for the smokers and 71 for the non-smoker 40.3% and 16.9% had severe plaque around their dental implants and the plaque severity was significantly different in the two groups (P = 0.008). The bone loss rates in the smokers and non-smoker groups were 1.57 ± 0.44 and 1.39 ± 0.44 mm, respectively, which were significantly different (P = 0.015). Conclusion: The health of soft and hard tissues around the dental implant is lower in smokers than non-smokers. Considering patients’ expectations for the cost of treatment for dental implants, patients who need dental implant therapy should receive proper care, training, and encouragement to quit smoking before their dental implant treatment.

Keywords: Dental implants, hard tissues, smoking


How to cite this article:
Rismanchian M, Givehchian P, Salmani S, Shaker F. Comparison of Hard and Soft Tissues Around Dental Implants in Smokers and Non-smokers. Dent Hypotheses 2020;11:86-90

How to cite this URL:
Rismanchian M, Givehchian P, Salmani S, Shaker F. Comparison of Hard and Soft Tissues Around Dental Implants in Smokers and Non-smokers. Dent Hypotheses [serial online] 2020 [cited 2020 Aug 9];11:86-90. Available from: http://www.dentalhypotheses.com/text.asp?2020/11/3/86/290460




  Introduction Top


Over the past decades, dental implant treatment has been developed extensively such that the number of volunteers who need dental implants has been on the rise. Although a dental implant is currently the best option for most of the toothless people, its success rate, factors affecting the success of treatment, and side effects have to be considered by therapists.[1] Recent studies have shown that some individual and behavioral factors and also dental implant characteristics affect the success rate of the dental implant. For example, medically compromised conditions like diabetes[2] or immunodeficiency diseases,[3] smoking,[4] and poor oral and dental hygiene[2],[3],[4],[5] are factors that affect success rates of dental implant therapy.

Due to the presence of more than 4000 types of toxic and chemical gases in cigarettes, smoking them reduces blood circulation, decreases collagen production, increases fibrinogen and Carboxy-Hemoglobin production, decreases neutrophils and macrophage activities and platelet adhesion, reduces protein production and fibroblasts adhesion, which cause impairment in tissue repair in smokers.[6],[7],[8],[9] Moreover, it may result in bone loss around the dental implant and ultimately leads to dental implant loss.[10]

Since such complications as infections and tooth loss in smokers are more common than non-smokers, treatment of these patients is more difficult and requires more attention.[11]

Many researchers have studied the success of dental implants in smokers. For the first time, Bain et al.[12] examined the extent of the failure of dental implant therapy in smokers and non-smokers. In smokers, treatment failure was significantly higher than that in non-smokers (11.28% vs. 4.76%). The results of the study showed that smoking was a significant risk factor for the failure of dental implant therapy. In the following years, further research has confirmed the finding.[13],[14],[15],[16] However, there are few studies and related details about this issue administered in Iran. Therefore, considering the above-mentioned cases and the fact that dental implant treatment has currently a high prevalence in the Isfahan province, and a good number of these patients are smokers, the present study was conducted to determine the effect of smoking on the success of dental implants. The null hypothesis of this study was the lack of correlation between smoking and the status of the soft and hard tissues surrounding the dental implant.


  Materials and Methods Top


This cross-sectional study was conducted in 2017 in Isfahan. The study population consisted of patients who were treated in the Dental Implant Department of Dentistry School, Isfahan University of Medical Sciences.

The inclusion criteria were patients who received dental implant treatment with a smoking history, the age range of 30–60 years, at least 6 months of prosthetic phase, and patients’ consent for participation in the study. The exclusion criteria were the occurrence of systemic diseases that affected the dental implant’s survival, lack of adequate information in the patient record, patients undergoing graft surgery, and patients who had quit smoking during this period.

A total of 30 smoker and 30 non-smoker patients treated in Isfahan were selected using the convenience sampling method. If the inclusion criteria were met, the patient was called and written consent was obtained if he wished to cooperate. Subsequently, the patients underwent clinical examination and radiography to examine their soft and hard tissue health indexes.

Patients’ records and radiograph images were examined carefully. After the first phase of the dental implant treatment (surgical phase), the patient had to have at least one radiography (panoramic radiography). Data included individual patients’ information, their medical history, surgical time, and prosthetic loading time.

To check the health of the soft tissue around the dental implant, the probing depth (PD), Bleeding On Probing (BOP), Gingival index (GI) and plaque index (PI) was evaluated.[17]

To evaluate the health of hard tissue, Marginal bone loss (MBL) was performed visually by panoramic radiography examined. MBL measurements were made from the reference point to the lowest observed point of contact of the marginal bone with the fixture. The reference point was the fixture-abutment interface. Calibration was performed with previously known values (e.g. fixture diameter, fixture length). All the measurements were made by one examiner.

The data were imported into the computer and analyzed using SPSS version 24 (IBM Corp., Armonk, NY, USA) for statistical tests of chi-square, ANOVA, Mann-Whitney, and t-test. The significance level was considered to be “P<0.05”.


  Results Top


Thirty smokers and 30 non-smokers treated with dental implants were studied. The number of dental implants in smokers and non-smokers were 72 and 71, respectively. The mean age of the two groups of smokers and non-smokers was 50.3 ± 6.9 and 51.7 ± 7.7 years, respectively. In the two groups, 27 and 17 patients were men and the rest were women (90% vs. 56.7%), respectively. The duration of dental implant treatment (time intervals from the initial phase of surgery) was 36.2 ± 7.4 and 42.1 ± 21.2 months, respectively. Other demographic and general variables, including the number of dental implants, dental implant placement, and the number of brushing times per day in the two groups are presented in [Table 1].
Table 1 Distribution of demographic and general variables in two groups

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The mean gingival health indices in smokers and non-smokers were 2.17 ± 0.63 and 1.77 ± 0.87, respectively. According to the t-test, the difference between the two groups was statistically significant (P<0.001).

According to [Table 2], the number of dental implants with healthy and non-inflamed gingiva in the smoker and non-smoker groups were 3 and 11 cases, respectively (4.2% vs. 15.5%). In contrast, the number of dental implants with gingivitis in the smoker group was 18 cases, while in the non-smoker group it was 9 (25% vs. 12.7%). According to the Mann-Whitney test, the severity of gingivitis was significantly different in the two groups (P=0.014).
Table 2 Mean of health indices of tissues around the implant in terms of demographic and general variables in two groups

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The mean PD index in all the dental implants was 2.77 ± 0.71 with a range of 1.25 ± 5.25. The mean in the smokers and non-smokers was 2.83 ± 0.73 and 2.7 ± 0.7 mm, respectively. According to the t-test, the difference between the two groups was not statistically significant (P=0.31).

According to the results of 72 dental implants for smokers and 71 for non-smokers, 11 and 17 cases (15.3% vs. 23.9%) had a mild plaque, 32 and 42 cases (44.4% vs. 59.2%, respectively) had a moderate plaque, and 29 and 12 cases (40.3% vs. 16.9%) had a severe plaque around their dental implants. The Mann-Whitney test showed that PI was significantly different in the two groups (P=0.008).

According to the results, in smokers, the amount of bone loss in their dental implants was between 0 and 2.60 mm (mean 1.57 ± 0.41 m). This rate was in the range of 0 to 1.95 mm for the non-smokers (mean 1.39 ± 0.44 mm). There was a significant relationship between bone loss and smoking (P=0.015). The BOP status was positive in both the smokers and non-smokers, though not statistically significant (P=0.99).

[Table 2] shows the mean and standard deviation of the health indexes surrounding the dental implant in terms of clinical and demographic variables. According to the t-test and one-way ANOVA, the gingival health index was significantly different in terms of the groups’ age, but the other three indices did not differ by the patients’ age. Gingival and plaque health indices were significantly different by the patients’ sex, and the frequency of brushing had a significant effect on all four indices; those who brushed twice a day had a more favorable status. As noted earlier, the non-smokers except for the PD index, had a more favorable status in the other indices.


  Discussion Top


Based on the results of this study, the null hypothesis was rejected and smoking was related to the STATUS (or health or any appropriate word) of around the dental implant.

So far, several factors have been investigated regarding the factors affecting the failure or reduction of dental implant survival time, and various theories and hypotheses have been presented in this regard. However, there are differences and contradictions.

According to the results of this study, the mean gingival health index in the smokers and non-smokers was 2.17 ± 0.63 and 1.77 ± 0.87, respectively, and non-smokers were more favorable than smokers. Also, frequency distribution of plaque status in the two groups of smokers and non-smokers revealed that of the 72 smoker patients and 71 non-smoker patients, 11 and 17 cases (15.3% vs 23.9%) had a mild plaque, 32 and 42 cases (44.4% vs 59.2%) had a moderate plaque, and 29 and 12 cases (40.3% vs 16.9%) had severe plaque around the dental implants. According to the Mann-Whitney test, plaque severity was significantly different in the two groups (P = 0.008). This result is different from a study carried out by Minsk et al.[18] Perhaps, one of the reasons for the difference is the lack of patients with poor oral hygiene in their study.

The mean PD index in the smokers was 2.83 ± 0.73 and 2.7 ± 0.7 mm in the non-smokers; an insignificant difference, which is consistent with the results of Rokn et al.[19]

The BOP was also positive in all the patients, though no significant difference was observed between the two groups, which is in line with the study by Sun et al.[20]

The results of the bone loss rate in the smoker and non-smoker patients ranged from 0 to 2.60 mm, respectively (mean 1.57 ± 0.44 m). The rate in the non-smoker patients ranged from 0 to 1.95 mm (mean 1.39 ± 0.44 mm), which had a significant correlation between smoking and bone loss, which is in agreement with the results of Johne et al.[13] who found that the rate of bone loss in smokers was higher than that of non-smokers. Moreover, in a similar study, Rokn et al.[19] found that the average bone loss in smokers was higher than non-smokers. Smoking is considered as a predisposing factor leading to failure of dental implant therapy. Since complications such as infection in smokers occur more than non-smokers, treatment of these patients is more difficult.[21] Smoking is associated with bone loss, loss of adhesion, and plaque formation.[22] So far, the results of several studies have demonstrated the effects of smoking on the tissue around the dental implant, which lead to dental implant failure due to infection and bone loss. In this regard, Bain et al.[12] showed more failure of the dental implant in smokers.

In Bruyane’s study, dental implant failure rates were higher in smokers.[14] Klokkevold, also, reported the negative effects of smoking on dental implants.[15] Moreover, according to Chrcanovic, the success rate of dental implants in smokers was lower than that of non-smokers.[16]

Minsk et al. found that the clinical success of intra-bone dental implants is influenced by the health of soft and hard tissues around the dental implant.[18] The reason is, perhaps, the lower level of oral hygiene in smokers, resulting in higher periodontal diseases and reduction in blood flow to tissues around the dental implant, due to smoking. The number of studies showing the effects of smoking on dental implant failure is high. Therefore, to prevent the failure of the dental implant and increase the implant survival, to deal with other complications associated with smoking, more emphasis should be put on smoking cessation in smokers who are applying for dental implant therapy.

There are several limitations with our study. The most important limitation of this study is the accuracy of MBL measurement using panoramic radiography. It is suggested that digital subtraction radiography method be used to increase the accuracy of MBL evaluation and due to the retrospective nature of this study, it was not possible to homogenize groups based on age, sex, type of implant, and duration of implant therapy. Hence, more longitudinal studies are recommended for future researches.


  Conclusion Top


According to the limitations of the present study, it can be stated that the health of soft and hard tissues around the dental implant in smokers is lower than non-smokers. According to the expectation of patients compared to the cost of dental implant treatment, smokers who require dental implant treatment should be seriously trained in oral health and encouraged to quit smoking before receiving dental implant therapy.

Acknowledgement

This study (No. 396452) was approved by the Research Deputy of Isfahan Dentistry School.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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De Bruyn H, Collaert B. The effect of smoking on early implant failure. Clin Oral Implants Res 1994;5:260-4.  Back to cited text no. 14
    
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Klokkevold PR, Han TJ. How do smoking, diabetes, and periodontitis affect outcomes of implant treatment? Int J Oral Maxillofac Implants 2007;22:173-202.  Back to cited text no. 15
    
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Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. J Dent 2015;43:487-98.  Back to cited text no. 16
    
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Crawford B. Implant installation in the smoking patient. Periodontology 2003;23:185-93.  Back to cited text no. 21
    
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