Imagine two people having the same implant placed in the same spot, one a daily smoker and one who has never smoked. Both will usually do well. But across large numbers of patients, the smoker's implant is noticeably more likely to fail and tends to lose more bone around it. Smoking does not normally rule implants out, though it is one of the main risks you can change before treatment.
What a large review found
A 2021 systematic review and meta-analysis by Mustapha, Salame and Chrcanovic in the journal Medicina brought together 292 publications covering about 35,500 implants in smokers and 114,600 in non-smokers. Implants in smokers had roughly 2.4 times the odds of failing, a similar increase in both the upper and lower jaw. Bone loss around the neck of the implant was also greater in smokers, by an average of about 0.58 mm. An earlier review by Chrcanovic and colleagues (Journal of Dentistry, 2015) reached the same direction of result for failure, postoperative infection and bone loss, while noting that the included studies had uncontrolled confounding factors, so the exact size of the effect should be treated with some caution.
Those are averages over many people. Your own risk also depends on how much you smoke, the health of your gums, the bone at the site, the type of treatment and how well the implant is looked after.
Why smoke gets in the way of healing
An implant has to join to the surrounding bone, a process described in our article on osseointegration, and the gum has to seal around it. Both rely on a good blood supply and a normal immune response. Tobacco smoke narrows small blood vessels, reduces oxygen in the tissues and dampens parts of the immune response in the gums, which may explain why wound healing and infection rates are worse in smokers. It can also mask early warning signs, because smokers' gums can bleed less even when inflammation is present.
Gum disease history adds to the picture
A history of periodontitis is a separate, well-established risk. The 2017 World Workshop review on peri-implantitis by Schwarz and colleagues found strong evidence that a history of chronic periodontitis, poor plaque control and no regular maintenance raise the risk of peri-implantitis. Interestingly, the same review rated the evidence linking smoking specifically to peri-implantitis as inconclusive, even though smoking clearly affects failure and bone loss in other studies. For someone who smokes and has had gum disease, getting the gums stable before surgery is especially important. Our guide to implants and gum disease explains the approach.
Vapes, waterpipes and other nicotine products
Research on alternatives is still catching up. A 2024 network meta-analysis by Vámos and colleagues in Nicotine and Tobacco Research compared peri-implant health in non-smokers with users of cigarettes, waterpipes, smokeless tobacco and e-cigarettes. Cigarette, waterpipe and smokeless tobacco users had significantly more bone loss around implants than non-smokers. E-cigarette users also had worse measurements on average, but the difference from non-smokers was not significant for many outcomes. The authors called for better studies, so vaping should not be assumed to be harmless for implants. Tell your dentist about any nicotine use, whatever the form.
Improving the odds if you smoke
Stopping altogether gives the greatest benefit for your implant and your general health. There is no single agreed time frame, but stopping well before surgery and staying off cigarettes through the healing period is the usual advice, and your GP, pharmacist or Quitline can help with support and nicotine replacement. If stopping is not possible yet, cutting down is still better than continuing as before.
Beyond that, treat any active gum disease first, keep the area around the implant very clean once it is in, and keep to regular maintenance visits so that inflammation is picked up early. Knowing the parts of an implant makes it easier to understand what needs cleaning. Smoking also stains natural teeth and some dental materials over time; how this affects implant crowns is covered in our article on whether implants stain.
Smoking and implants: common questions
Will I be turned away for an implant because I smoke?
Usually not. Smoking is a risk factor rather than an automatic barrier. Your dentist will explain your individual risks, discuss stopping or cutting down, and plan treatment and maintenance with it in mind.
Does it still matter after the implant has healed?
Yes. The review evidence links smoking with more bone loss around implants, not only with early healing problems, so it is likely to keep mattering for as long as you smoke.
Are several implants riskier than one?
Each implant carries its own risk, so more implants mean more sites where something could go wrong. Smoking is one of the factors weighed more carefully in larger treatment plans.
If you smoke and are thinking about implants, an honest talk about your own risks and what you can do to improve them is the right first step. Lumi Dental in Melrose Park offers a free implant consult; you can read more on our dental implants page and see what is current on our deals page.
This article is general information only and is not a substitute for an individual dental assessment.
