Mazor et alDisclosure: 20. Piattelli A, Scarano A, Corigliano M, Piattelli M. Comparison of boneDrs. Alexander and Mamidwar are employees of Orthogen. regeneration with the use of mineralized and demineralized freeze-dried bone allografts: a histological and histochemical study in man. BiomaterialsReferences: 1996;17(11):1127-1131.1. Crubezy E, Murail P, Girard L, Bernadou JP. False teeth of the Roman world. 21. Dreesman H. Ueber knochenplombierung. Beitr Klin Chir 1892;9:804-810. Nature 1998;391(6662):29. 22. M amidwar SS, Arena C, Kelly S, Alexander H, Ricci J. In vitro characterization2. W estbroek P, Marin F. A marriage of bone and nacre. Nature of a calcium sulfate/PLLA composite for use as a bone graft material. J Biomed 1998;392(6679):861-2. Mater Res B Appl Biomater 2007;81(1):57-65.3. S hibli JA, Piattelli A, Iezzi G, Cardoso LA, Onuma T, de Carvalho PS, Susana D, 23. Ricci J, Alexander H, Nadkarni P, Hawkins M, Turner J, Rosenblum S. Biological Ferrari DS, Mangano C, Zenobio EG. Effect of smoking on early bone healing mechanisms of calcium sulfate replacement by bone. Toronto: EM Squared Inc; around oxidized surfaces: a prospective, controlled study in human jaws. J 2000. Periodontol;81(4):575-83. 24. S trocchi R, Orsini G, Iezzi G, Scarano A, Rubini C, Pecora G, Piattelli A. Bone4. Pizzo G, Lo Re D, Piscopo MR, Pizzo I, Giuliana G. Genetic disorders and regeneration with calcium sulfate: evidence for increased angiogenesis in periodontal health: a literature review. Med Sci Monit 2009;15(8):RA167-78. rabbits. Journal of Oral Implantology 2002;28(6):273-278.5. Joshipura K, Zevallos JC, Ritchie CS. Strength of evidence relating 25. Pecora G, Baek S, Rethnam S, Kim S. Barrier membrane techniques in periodontal disease and atherosclerotic disease. Compend Contin Educ Dent endodontic microsurgery. Dental Clinics of North America 1997;41(3):585. 2009;30(7):430-9. 26. Guarnieri R, Pecora G, Fini M, Aldini N, Giardino R, Orsini G, Piattelli A. Medical6. Zadik Y, Sandler V, Bechor R, Salehrabi R. Analysis of factors related to grade calcium sulfate hemihydrate in healing of human extraction sockets: extraction of endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral clinical and histological observations at 3 months. Journal of Periodontology Radiol Endod 2008;106(5):e31-5. 2004;75(6):902-908.7. Becker W, Clokie C, Sennerby L, Urist M, Becker B. Histologic findings 27. W alsh W, Morberg P, Yu Y, Yang J, Haggard W, Sheath P, Svehla M, Bruce W. after implantation and evaluation of different grafting materials and titanium Response of a calcium sulfate bone graft substitute in a confined cancellous micro screws into extraction sockets: case reports. Journal of Periodontology defect. Clinical orthopaedics and related research 2003;406(1):228. 1998;69(4):414. 28. Sottosanti J. Calcium sulfate-aided bone regeneration: a case report.8. M cAllister BS, Haghighat K. Bone augmentation techniques. J Periodontol Periodontal clinical investigations: official publication of the Northeastern 2007;78(3):377-96. Society of Periodontists 1995;17(2):10.9. M ecall RA, Rosenfeld AL. Influence of residual ridge resorption patterns on 29. De Leonardis D, Pecora GE. Augmentation of the maxillary sinus with calcium implant fixture placement and tooth position. 1. Int J Periodontics Restorative sulfate: one-year clinical report from a prospective longitudinal study. Int J Oral Dent 1991;11(1):8-23. Maxillofac Implants 1999;14(6):869-78.10. Pietrokovski J, Massler M. Alveolar ridge resorption following tooth extraction. 30. H an T, Jeong WC. Bone and Crescent Shaped Free Gingival Grafting for The Journal of Prosthetic Dentistry 1967;17(1):21. Anterior Immediate Implant Placement Technique and Case Report. Journal of Implant and Advanced Clinical Dentistry 2009;1(5).11. Fiorellini J, Howell T, Cochran D, Malmquist J, Lilly L, Spagnoli D, Toljanic J, Jones A, Nevins M. Randomized study evaluating recombinant human bone 31. Irinakis T, Perio D. Rationale for socket preservation after extraction of a single- morphogenetic protein-2 for extraction socket augmentation. Journal of rooted tooth when planning for future implant placement. J Can Dent Assoc Periodontology 2005;76(4):605-613. 2006;72(10):917-22.12. Vance G, Greenwell H, Miller R, Hill M, Johnston H, Scheetz J. Comparison of 32. S chropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue an allograft in an experimental putty carrier and a bovine-derived xenograft used contour changes following single-tooth extraction: a clinical and radiographic in ridge preservation: a clinical and histologic study in humans. The International 12-month prospective study. International Journal of Periodontics and Journal of Oral & Maxillofacial Implants;19(4):491. Restorative Dentistry 2003;23(4):313-324.13. Iasella J, Greenwell H, Miller R, Hill M, Drisko C, Bohra A, Scheetz J. Ridge 33. N orton M, Wilson J. Dental implants placed in extraction sites implanted with preservation with freeze-dried bone allograft and a collagen membrane bioactive glass: human histology and clinical outcome. The International Journal compared to extraction alone for implant site development: a clinical and of Oral & Maxillofacial implants;17(2):249. histologic study in humans. Journal of Periodontology 2003;74(7):990-999. 34. Kameda T, Mano H, Yamada Y, Takai H, Amizuka N, Kobori M, Izumi N,14. Becker W, Becker B, Caffesse R. A comparison of demineralized freeze-dried Kawashima H, Ozawa H, Ikeda K. Calcium-sensing receptor in mature bone and autologous bone to induce bone formation in human extraction osteoclasts, which are bone resorbing cells. Biochemical and biophysical sockets. Journal of Periodontology 1994;65(12):1128. research communications 1998;245(2):419-422.15. Hamilton D. On sponge-grafting: Printed by Oliver and Boyd; 1881. 35. P odaropoulos L, Veis A, Papadimitriou S, Alexandridis C, Kalyvas D. Bone regeneration using beta-tricalcium phosphate in a calcium sulfate matrix. The16. Shin H, Sohn D. A method of sealing perforated sinus membrane and histologic Journal of oral implantology 2009;35(1):28-36 finding of bone substitutes: A case report. Implant Dentistry 2005;14(4):328. 36. Froum S, Cho S, Rosenberg E, Rohrer M, Tarnow D. Histological comparison17. A rtzi Z, Tal H, Dayan D. Porous bovine bone mineral in healing of human of healing extraction sockets implanted with bioactive glass or demineralized extraction sockets: 2. Histochemical observations at 9 months. Journal of freeze-dried bone allograft: a pilot study. Journal of Periodontology Periodontology 2001;72(2):152-159. 2002;73(1):94-102.18. Koutouzis T, Lundgren T. Crestal Bone Level Changes Around Implants Placed 37. P ecora G, De Leonardis D, Della Rocca C, Cornelini R, Cortesini C. Short- in Post Extraction Sockets Augmented with Demineralized Freeze-Dried term healing following the use of calcium sulfate as a grafting material for sinus Bone Allograft (DFDBA): A Retrospective Radiographic Study. Journal of augmentation: a clinical report. International Journal of Oral and Maxillofacial Periodontology (0):1-3. Implants 1998;13:866-873.19. B ecker W, Urist M, Becker BE, Jackson W, Parry DA, Bartold M, Vincenzzi G, De Georges D, Niederwanger M. Clinical and histologic observations of sites implanted with intraoral autologous bone grafts or allografts. 15 human case reports. J Periodontol 1996;67(10):1025-33. The Journal of Implant & Advanced Clinical Dentistry • 49
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The Influence of Smoking on Noorwali et alModerately Rough-Surfaced Dental Implants:A Literature Review Osama Noorwali BDS, SSC-ARD1Hassan Ali Alremthi BDS, AEGD, SSC-ARD2 Douglas Deporter DDS, PhD3AbstractSmoking cigarettes has been shown to was to assess published information on any be detrimental for dental implant health relationship between smoking cigarettes and as it is for periodontal health. Most rough-surfaced implant performance. An Eng-studies published to date relate to the risk of lish literature search was done using PubMedsmoking in patients with machine-turned den- & Ovid Medline to identify relevant papers pub-tal implant designs like the original Branemark- lished between 2000 and 2010. No consen-type implant. However, increasing implant sus could be found possibly due to differingsurface roughness can have a profound effect study designs and confounding factors suchon osteoconduction and early bone healing as a history of periodontal disease. Prospec-around implants, and this has been suggested tive, split-mouth studies comparing machine-to provide a benefit for smokers wishing to turned and moderately rough implant designshave implants. The aim of the present paper in smokers vs non-smokers are sadly lacking. KEY WORDS: Dental implant, smoking, surface roughness, literature review1. Restorative Specialist in Directorate for Health Affairs of Jeddah, Ministry of Health, Saudi Arabia2. Restorative Specialist in Directorate for Health Affairs of Bisha, Ministry of Health, Saudi Arabia 3. Professor, Discipline of Periodontology, Faculty of Dentistry, University of Toronto The Journal of Implant & Advanced Clinical Dentistry • 51
Noorwali et al INTRODUCTION sive integration17 and a stronger bone-to- implant interface.18-20 They may21-23 or mayDifferent biological and mechanical not24 reduce crestal bone loss compared toparameters are considered to impact machine-turned surfaces, although other fac-successful outcomes of dental implant tors such as coronal micro-threads25 and/ortreatment.1 Most investigators agree “platform-switching”26 may be equally or morethat smoking has a significant detrimen- important. In any event, this led to the sugges-tal effect, affecting both initial implant tion that moderately rough-surfaced implantsintegration2,3 and long-term4-8 implant may experience less crestal bone loss thanhealth via nicotine and other toxins.9,10 machine-turned surfaces in smokers. This question was the focus of the present paper. Bain and Moy4 reported the effect of smok-ing in a retrospective assessment of 2,194 RATIONALEmachine-turned, threaded implants in 540patients. Over a 6-year period, smokers experi- The goal of this paper was to review pub-enced an 11.3% failure rate compared to 4.8% lished data on the effect of surface rough-failure in non-smokers. The greatest effect was ness on implant failure and crestal bone lossseen in posterior maxilla (19.1% vs 10.9%) and around dental implants in smokers. Both stud-the smallest effect in posterior mandible (4.6% ies of moderately rough (e.g. acid-washedvs 3.8%). Interrupting cigarette usage was and/or particle-blasted) and rough (e.g. tita-shown to improve initial integration outcomes nium plasma-sprayed –TPS or hydroxyapatitefavorably.11 However, long-term success of – HA plasma-sprayed) surfaces were included.smoking cessation programs is poor with mostindividuals reverting to their previous smok- SEARCH METHODOLOGYing status,12 so that the long-term effects ofcigarette smoking will continue to be an issue. Literature searches of peer-reviewed papers in the electronic databases PubMed & Ovid Most early data on cigarette smoking and Medline were conducted using the keywords:implants related to machine-turned implants ”smoking and dental implant” and “smokinglike the original Branemark-type design. More and surface properties” to identify relevantrecently, some investigators have proposed papers published in English between yearsthat using surface-modified implants in smok- 2000 and 2010. Additional papers includeders may offer some advantage. Currently, in references lists of identified papers but pre-most commonly used threaded dental implant ceding year 2000 also were reviewed. To bedesigns incorporate moderately rough (1 to included in the database, publications needed2µm roughness)13 surfaces created by subtrac- to provide information regarding implant sur-tive (e.g. acid-washing and/or particle-blast- vival rate and/or radiographic crestal boneing) or additive (e.g. thickened oxide layers) loss. Publications were excluded if they com-procedures. Such surfaces are reported to bined data for rough- and machined-surfacedoffer several advantages over machine-turned implants. A total of 18 usable studies weresurfaces including faster14-16 and more exten-52 • Vol. 3, No. 5 • July/August 2011
Noorwali et alTable 1: Studies with data for smokers and non-smokers with rough-surfaced implants only Statistically Rough Study Outcomes Significant Sample Observation Study Implant Smokers vs Not Size Period Design Characteristics No effect of Kumer et al smoking on No 1183 implants 18 months Retrospective Large grit blast 2002 initial 461 patients & acid-etched integration Smoking did Grunder et al not affect No 219 implants 20 months Prospective Acid-washed 1999 initial 74 patients integration Smoking Al Saadi et al affected Yes 720 implants Up to Prospective Oxidized 2008 initial 283 patients re-entry integration (p<0.001) Vanderweghe Early implant & De Bruyn failure 3x Yes 712 implants Up to Retrospective Particle-blasted 2009 higher in 329 patients 6 months function smokers Crestal bone Garcia-Bellosta loss with No 980 implants 5 years Retrospective Particle-blasted et all 2010 surviving 323 patients implants not reported Significantly Wennstrom greater crestal Yes 149 implants 5 years Prospective Particle-blasted et al 2004 bone loss in 51 patients smokers over 5-year functional period Failures in Kinsel 41.7% of No 344 implants 2-10 years Retrospective TPS-coated or & Liss 2007 smokers vs 43 patients large grit blast 16.1% of & acid-etched non-smokers Significantly Penarrocha greater Yes 108 implants 1 year Retrospective Large grit blast et al 2004 (p<0.01) 42 patients & acid-etched bone loss in smokers Only # of yrs Mundt et al of smoking Yes 663 implants 10 years Retrospective Ceramic 2005 was significantly 159 patients particle-blasted associated with increased implant loss Smoking Karousis et al significantly Yes 179 implants 10 years Prospective Large grit blast 2002 correlated 127 patients & acid-etched (p<0.001) to alveolar bone loss Significantly Chuang et al greater Yes 2349 implants 8 years Retrospective Particle-blasted 2002 (p<0.01) implant 677 patients & acid-etched loss in smokers The Journal of Implant & Advanced Clinical Dentistry • 53
Noorwali et al Table 2: Studies reporting data for smokers and non-smokers with rough-surfaced and machine-turned implants Sample Observation Study Rough Implant Study Outcomes Size Period Design Characteristics Lambert HA-coated implants may 1094 Non-HA & et al have a clinical benefit 1793 HA-coated 3 years Prospective HA-coated 2000 implants over non-cated implants for smokers Watzek Ti-Unite® implants 31 patients et al showed less crestal bone 124 implants 33 months Retrospective Oxidized 2006 loss than machine-turned Rocci et al Early failure of 44 patients 2003 Ti-Unite® implants not 121 implants One year Prospective Oxidized affected by smoking Balshe Machine-turned 593 patients et al implants failed 3.1x more 4607 implants 5 years Retrospective Oxidized 2008 than Ti-Unite® in smokersfound, and these were categorized into in 3 impact of smoking on initial implant site heal-groups: 1) studies that reported data between ing seen with machine-turned implants. Similarsmokers and non-smokers on rough-surfaced findings had earlier been reported by Grunderimplants only; 2) studies that reported sepa- et al.28 These clinicians provided data on therate data for smokers and non-smokers with performance of 219 acid-washed (Osseotite,rough- and machine-surfaced implants; and, BIOMET 3i, Palm Beach Gardens, FL) implants.3) studies that reported data for rough- and Of 74 patients treated, 19 were smokers whomachine- surfaced implants for smokers only. reported having a mean of 13.2 cigarettes per day. Only 3 implants failed, and all fail- REVIEW OF LITERATURE ures were due to infection. None of the 3 fail- ures occurred in smokers which led the authorsStudies reporting data for smokers and non- to suggest that smoking did not affect initialsmokers with rough-surfaced implants only are implant integration with this type of implant.shown in Table 1. Kumar et al27 published a ret-rospective study on the effects of smoking (≥ In contrast, Alsaadi et al.29 reported signifi-½ pack per day) on initial integration of SLA, cantly better (<0.001) rates of initial integra-i.e. particle-blasted and acid-washed, (Strau- tion for moderately rough (Ti-Unite® anodicmann USA, Waltham, MA) implants. During an oxidized, Nobel Biocare, Gothenburg, Swe-18-month period, 1183 implants were placed in den) implants in non-smokers vs smokers461 patients. Successful integration occurred (98.9% vs 94.4%), probably due to a poorwith 97% vs 98.4% of implants in smokers vs bone healing response in the smokers30. Simi-non-smokers. Outcomes did not differ in max- larly, Vandeweghe & De Bruyn31 provided ret-illa vs mandible. This led the authors to suggest rospective data on initial implant integration ofthat using moderately rough implants in smok- 712 particle-blasted (Southern Implants, Irene,ers might be one way to overcome the negative South Africa) implants in smokers vs non-smok-54 • Vol. 3, No. 5 • July/August 2011
Noorwali et alers. The results showed that smokers had a 3 lox implants; Dentaurum, Ispringen, Germany).times higher early failure rate (4.8% vs 1.2%). The survival rate of 663 implants in 159Similar to data using machine-turned implants4,the effect of smoking was particularly strong in patients was 91.8% after 10 years. Only themaxilla with 9.8% failure in smokers vs 1.1% number of years of smoking was significantlyin non-smokers. Regarding long-term implant associated with an increased risk of implant fail-performance, Garcia-Bellosta et al32 published ures. Failure rates were 15% for current smok-a retrospective assessment of smokers treated ers, 9.6% for former smokers and, 3.6% forwith particle-blasted implants (Astra-Tech, nonsmokers. Both Chuang et al37 and KaroussisMolndal, Sweden). Data was available for 323 et al38 published similar findings for moderatelypatients who had received 980 implants. Smok- rough and rough threaded implants respectively.ers received 38.8% of the implants. The cumu-lative survival rate at up to 5 years was 96.2%, Studies that reported differences betweenand the authors reported no effect of smoking smokers and non-smokers using both rough-or a history of treated periodontitis on implant surfaced and machine-turned implants areloss. Crestal bone loss affecting the surviv- shown in Table 2. Lambert et al.39 reporteding implants was not reported. However, using 3-year data from a large Veterans Affairs studythe same implant system, Wennstrom et al33 which looked at the effect of smoking on HAobserved significantly greater crestal bone loss plasma-coated (rough-surfaced13; >>2µmin smokers over a 5-year functional period. Kin- roughness) vs non-coated, machine-turnedsel and Liss34 reported 2- to 10-year follow-up implants. Based on implant loss only, bothon a group of 43 patients with 56 edentulous implant types were 1.5 times more likely to failarches treated with fixed prostheses supported in smokers. However, the rough HA-surfacedby either Straumann TPS-coated or SLA-sur- implants failed less often during the 3-yearfaced implants. The total number of implants period than did the non-coated (i.e. machine-included in the analysis was 344. Twelve of turned) implants in both patient groups. Forthe 43 patients were smokers (minimum of 20 example, in smokers failure rates of rough vscigarettes/day). The data showed that failures machine-turned implants were 4.8% vs 16.0%.occurred in 41.7% of smokers vs 16.1% of non- In the extreme scenario of a comparison of asmokers, although oddly this difference was machine-turned implant in a smoker vs an HA-reported as not being statistically significant. coated implant in a non-smoker the former wasPenarrocha et al35 assessed bone loss around 6 to 7 times more likely to fail. The problemSLA-surfaced implants and after 1 year in func- with plasma-sprayed HA-coated implants, how-tion found that implants placed in individuals ever, was that the HA-to-implant interface waswho smoked 11 to 20 cigarettes/day showed a weak one, and the coatings tended to delami-significantly greater bone loss than those in nate resulting in implant loosening and failurenon-smokers. Mundt et al.36 studied risk fac- as time in function increased. Nevertheless,tors for ceramic particle-blasted implants (Tio- the data did suggest that a surface coating of HA could have a clinically significant benefit over machine-turned implants in patients who The Journal of Implant & Advanced Clinical Dentistry • 55
Noorwali et alsmoke. There are now methods to create ultra- Rocci et al.43 introduced another variablethin HA-type coatings40 that do not delaminate, by assessing outcomes of immediate loadingbut no relevant data could be found compar- with machine-turned and TiUnite® implants ining this type of surface treatment on implant posterior mandible of smokers vs non-smokers.performance in smokers vs non-smokers. Again, the sample size was small. Twenty-two patients, of whom 7 were cigarette smokers, Watzek et al.41 reported retrospective data received 66 TiUnite® implants, while another 22on the performance of machine-turned vs Ti- patients, of whom 5 were smokers, were treatedUnite® implants in smokers ( > 10 cigarettes/ with 55 machine-turned implants. Patients wereday) and non-smokers. Thirty-one patients with restored with 2- to 4-unit fixed bridges placededentulous mandibles who each had been on the day of implant insertion. Three TiUnite®treated with 4 inter-foraminal implants and a and 8 machine-surfaced implants failed withinbar-retained overdenture were recalled after the first 7 weeks of loading so that after 1 yeara mean functional time of 33 months. Sixteen of prosthetic loading, the failure rates werepatients, of whom 5 were smokers, received 14.5% vs 4.5% for machine-turned vs mod-machine-turned implants, while 15 patients, erately rough implants. With machine-turnedof whom 4 were smokers, received the mod- implants, failures were higher in smokers, buterately rough implants. All implants were suc- this effect of smoking was not seen with thecessfully integrated, but one Ti-Unite implant TiUnite® implants. Marginal bone loss at 1 yearfailed after 3 months function. The authors was similar for both implant types (0.9mm forreported that the moderately rough implants TiUnite® and 1.0mm for machine-turned), butshowed less crestal bone loss than machine- the sample size was too small to assess theturned implants (1.08mm vs 1.83mm). Cau- effect of smoking. The difference in outcometion is advised when interpreting these data, therefore was likely due to the faster and morehowever, since the sample size was very small extensive bone-to-implant contact likely to haveand the bone measurements were made with happened with the moderately rough implantspanoramic radiographs which are known to in the early stages of healing.14 Longer termbe inaccurate for this purpose.35 Balshe and data on crestal bone loss will be needed to seecoworkers42 reported retrospective data on if differences between the two implant typesthe effect of smoking on machine-turned vs appear over time, and if smoking has an impact.Ti-Unite® implants. The data included thosefrom 593 patients with 2,182 machine-turned Regarding comparisons of rough- andimplants and 903 patients with 2,425 Ti-Unite® machine-surfaced implants in smokers only,implants. Failure was defined by implant loss D’Avil et al44 studied initial integration of mod-only. Smoking was identified as a risk factor erately rough (Al3O2 particle-blasted and acid-only for the machine-turned implants. Among washed) and machine-turned micro-implantssmokers, machine-turned implants were 3.1 in seven partially edentulous patients whotimes more likely to fail than Ti-Unite® implants, smoked cigarettes ( >10/day). One of eachbut not data on crestal bone loss was provided. implant type was placed in posterior maxilla56 • Vol. 3, No. 5 • July/August 2011
Noorwali et alof each patient to allow an intra-patient com- may be a confounding factor since at least oneparison. As with earlier studies, the results study38 showed that even so few cigarettes hadshowed more extensive bone contact dur- a significant effect on peri-implant crestal boneing the initial integration period of 2 months levels, at least in patients with a history of peri-with the moderately rough implants (22.2% vs odontal disease and treatment. Combining cur-10.4%). Aglietta et al.45 reported 10-year data rent smokers and past smokers (currently notfor both machined-turned and rough (TPS smoking) may create confusion.47 Differencesplasma-sprayed) threaded implants in smok- in the amount of inhalation and toxicity of dif-ers who did or did not also have periodontally ferent cigarette types also may impact results.compromised (supportive periodontal main- As well, it has been shown that smoking maytenance treatment was provided for these have a greater effect in patients with a historypatients) mouths. The cumulative survival rate of periodontitis compared to those who havefor all implants after 10 years was 90%, but the not needed treatment for periodontitis in therough implants in periodontally compromised past.8,45-49 In their review of literature, Quirynensmokers had a 20% failure, while the same et al.50 determined that regular periodontalimplants in periodontally healthy smokers had and peri-implant maintenance treatment was ano failures based on implant loss. However, key factor in avoiding complications with mod-crestal bone loss after 10 years was signifi- erately rough implants in patients with a his-cantly higher for the rough implants in both peri- tory of treated periodontitis. In many studies,odontally compromised and healthy patients. this factor was not considered. Furthermore,Similar results were reported by Baelum and bias, either unintentional or intentional, may beEllegaard.46 These investigators compared introduced by relying on patients’ self-report-TPS-coated (rough) and particle-blasted (mod- ing of smoking habits.51 What is lacking areerately rough) threaded implants in periodon- prospective studies designed to investigatetally compromised patients who were seen for the effects of ongoing smoking on long-termmaintenance every 3 months. Based on implant implant performance in patient populations wholoss, the 10-year failure rates were 22% for the have remaining dentitions that are or are notrough vs 3% for the moderately rough implants, periodontally compromised. Smoking statusbut failures in smokers were 2.6 times higher would need to be carefully categorized perhapsthan in non-smokers for both implant types. using blood nicotine levels rather than patient self-reporting. Finally, in addition to implant It is clear from the studies reviewed in this loss, surviving implants need to be assessedpaper that there remains confusion regarding carefully for crestal bone loss over timethe effect of smoking cigarettes on outcomes using appropriate radiographic technique.52with moderately rough- and rough-surfaceddental implants. Various factors may be con- CONCLUSIONtributing to the conflicting reports. Firstly, inmany studies, “non-smokers” included individu- The literature reviewed here confirms that smok-als smoking ≤10 cigarettes per day, and this ing cigarettes may have a significant detrimental The Journal of Implant & Advanced Clinical Dentistry • 57
Noorwali et al The Journal of Implant & Advanced Clinical Dentistry effect on early wound healing with moderately rough and rough-surfaced dental implants, as ATTENTION it does with machined-turned implants. WithinPROSPECTIVE smokers, moderately rough surfaces do appear to promote faster and more extensive integra- AUTHORS tion than do machine-turned surfaces. As well, within smokers, moderately rough implants may JIACD wants perform better over time than machine-turned to publish implants. Nevertheless, with either implant your article! type failures will be greater in smokers than in non-smokers. Much more work will be required For complete details using prospective, split-mouth study designs regarding publication in including collection of good quality radiographs. Until this data becomes available, clinicians are JIACD, please refer advised to ensure all patients seeking implant to our author guidelines at treatment are urged to cease smoking on a per- manent basis, especially if implant-borne res- the following link: torations are required in posterior maxilla. ● http://www.jiacd.com/ Correspondence: authorinfo/ Dr. Douglas Deporter author-guidelines.pdf Faculty of Dentistry, University of Toronto, 124 Edward Street or email us at: Toronto, ON, Canada, M5G 1G6 [email protected] [email protected] • Vol. 3, No. 5 • July/August 2011
Noorwali et alDISCLOSURE 20. K hang W, Feldman S, Hawley CE, Gunsolley J. 36. Mundt R, Mack F, Schwahn C, Biffar R. PrivateThe authors report no conflicts of interest with A multi-center study comparing dual acid-etched practice results of screw-type tapered implants:anything mentioned in this article. and machined-surfaced implants in various bone Survival and evaluation of risk factors. Int J OralREFERENCES qualities. J Periodontol 2001; 72: 1384-1390. Maxillofac Impl 2006; 21: 607-614.1. E sposito M, Hirsch J-M, Lekholm U, Thomsen 21. Z echner W, Trinki N, Watzak G, Busenlechner 37. Chuang S, Wei L, Douglass C, Dodson T. Risk P. Biological factors contributing to failures D, Tepper G, Haas R, Watsek G. Radiographic factors for dental implant failure: A strategy os osseointegrated oral implants. (II) follow-up of peri-implant bone loss around for the analysis of clustered failure-time Etiopathogenesis. Eur J Oral Sci 1998; 106: machine-surfaced and rough-surfaced observations. 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