The Effects of Smoking Cigarettes on Immediate Dental Implant Stability—A Prospective Case Series Study

Background: Smoking tobacco significantly affects the biology of periodontal tissues and contributes to the increased risk of peri-implant diseases. The aim of the study was to investigate whether smoking cigarettes affects the primary and secondary stability of maxillary dental implants, inserted into fresh sockets immediately after extraction. Methods: The study was conducted on 164 patients between the ages of 27–71 years old. 67 individuals smoked more than 20 cigarettes daily and 97 were non-smokers. 190 immediate implants were inserted in the maxilla. Immedi- ate implantations were performed with simultaneous augmentation of the socket with xenogenic bone grafting material. In the posterior region, implants were inserted into the palatal alveolus. The stability of the implants was measured using Insertion Torque Value (ITV) and two types of devices: Periotest (PT) and Osstell (ISQ). Marginal bone loss was evaluated on cone beam computed tomography scans. Results: In an aesthetic area, the PT values at 6 months post-implantation were higher for smokers than non-smokers (p < 0.05), respectively. The ISQ values were significantly lower in smokers compared to non-smokers at 6 months post-implantation (p = 0.0226), respectively. In the posterior region PT values were higher in smokers both on the day of implantation (p = 0.0179), 6 months after surgery (p = 0.0003) as well as 24 months after surgery (p < 0.0001 ), as compared to non-smokers, respectively. Smokers revealed lower ISQ values than non-smokers (p = 0.0047) on the day of implantation, as well as 6 months after implantation (p = 0.0002), respectively. There were no significant differences in marginal bone loss after 18 months of loading between smokers and non-smokers in the aesthetic, as well as posterior regions (p > 0.05). ITV measurements were lower in smokers than non-smokers in the aesthetic (16.3 vs. 17.5 Ncm) and posterior area (16.8 vs. 17.9 Ncm). Conclusions: This study indicate that smoking cigarettes has a negative effect on the stability of immediate implants in the maxilla. Primary stability of immediate implants may be lower in the posterior area of the maxilla in smokers when compared to non-smokers, which may eliminate smokers from immediate implants in this region. Secondary stability of immediate implants may be lower in both the aesthetic and posterior areas in smokers compared to non-smokers, which may encourage the postponement of final crowns delivery at 6 months post op and the extension of the occlusaly temporary crowns use in some smoker cases.