The incidence of peri-implantitis is increased in smokers with an odds ratio of 3.6 to 4.6.32-34 A meta-analysis across 13 studies found that smoking increased the annual rate of bone loss around dental implants by 0.164mm/year.35 In smokers, even apparently healthy peri-implant sites have increased levels of IL-1β, TNF-α, and prostaglandin E2 levels in peri-implant crevicular fluid when compared to non-smokers.36