Smoking has been shown to have many negative effects on the oral cavity and wound healing after procedures, such as reduction in neutrophil chemotactic response, vasoconstriction, alterations in innate and adaptive immune response, an increase in number or proportion of periopathogenic bacteria, and a decrease in fibroblast number and collagen production.64 These effects of smoking can lead to chronic inflammation at periodontal and peri-implant tissues. Patients who smoke have been shown to have up to two times the failure rate of implants compared to non-smokers.65 Smoking itself, independent of periodontal health, is a predisposing factor in implant failure and development of peri-implant diseases.65 Smoking cessation is an important contributing factor to implant success; even though cessation cannot reverse past effects it can increase implant success rates to that of nonsmokers.66 Supportive implant therapy in patients who smoke has also shown a benefit in reducing rates of peri-implantitis that is of larger magnitude than that seen in non-smokers.67
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