Effect of waterpipe smoking on peri-implant health: A systematic review and meta-analysis

Electronic Cigarettes and Peri-Implantitis: An Umbrella Review

Electronic cigarettes (e-cigarettes) are offered to consumers as a healthier option than traditional tobacco. However, the long-term effect of non-heat-burning tobacco and e-cigarettes on periodontal and peri-implantitis is unknown. The present review evaluates the impact of electronic cigarettes on peri-implantitis and compares the results with traditional cigarettes and nonsmokers. Systematic/meta-analysis studies were searched in PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar until December 30, 2022. Five systematic/meta-analysis studies were identified based on the search strategy in the selected databases. The overall quality assessment of the studies showed acceptable evidence with high quality. All systematic review studies showed that compared with traditional tobacco smoke, electronic cigarettes might reduce or not change the clinical inflammatory symptoms of periodontitis and peri-implantitis, such as bleeding on probing, probing depth, peri-implant bone loss, and response to treatments. Electronic cigarettes contain nicotine, which can harm periodontal and implant health. On the other hand, a wide range of oral health consequences may be associated with using e-cigarettes. E-cigarette is a potential risk factor for the healing process and the results of implant treatment.

The Effect of Nicotine-Containing Products on Peri-Implant Tissues: A Systematic Review and Network Meta-Analysis

INTRODUCTION

Smokers have a higher chance of developing peri-implant diseases and are therefore considered an at-risk population. Our aim was to compare peri-implant characteristics in users of electronic cigarettes (EC), waterpipes (WP), cigarettes (CS), smokeless tobacco (ST), and nonsmokers (nonusers of any nicotine and tobacco product; NS).

AIMS AND METHODS

A systematic search of four electronic databases (PubMed, EMBASE, Web of Science, and CENTRAL) was performed until April 2023, restricted to English language. Thirty-nine observational studies were included in the qualitative synthesis, of which 32 studies were included in a Bayesian network meta-analysis. Using a predesigned form, two researchers independently collected data about marginal bone loss (MBL), probing pocket depth (PPD), plaque index, bleeding on probing, modified plaque index, probing pocket depth > 4 mm (PPD > 4), gingival index, peri-implant sulcular fluid volume, and TNF-α and IL-1β levels. QUIPS and CINeMA were used to evaluate the risk of bias and certainty of evidence.

RESULTS

Nonsmokers had the smallest MBL. Most nicotine-containing product users had significantly higher MBL (CS, mean difference [MD]: 1.34 credible interval [CrI]: 0.85, 1.79; WP, MD: 1.58 CrI: 0.84, 2.35; ST, MD: 2.53, CrI: 1.20, 3.87) than NS. Electronic cigarettes did not show significant difference compared to NS (MD: 0.52 CrI: -0.33, 1.36). In secondary outcomes, NS were ranked in first place. Subset analysis based on smoking habit, implant duration, and maintenance control revealed no differences in ranking probability.

CONCLUSIONS

Most nicotine-containing product users presented worse peri-implant parameters compared to NS, while EC users did not show significant differences to NS in many outcomes.

IMPLICATIONS

Alternative nicotine-containing products are gaining popularity and are often considered less harmful by the general public compared to traditional cigarettes. This is the first network meta-analysis comparing users of four nicotine-containing products and NS. This study shows that CS, WP, and ST have a detrimental effect on the overall health of peri-implant tissues. EC users also presented inferior parameters compared to NS; however, the difference was not significant in many outcomes. It is essential to educate patients who are using nicotine-containing products, and to provide proper maintenance and appropriate cessation support. Well-designed multiarmed studies are needed for direct comparison of different products, including heated tobacco products. Greater transparency of confounding factors is needed regarding smoking habit and oral hygiene.

Evidence-Based Critical Assessment of the Success Rate of Dental Implants in Smokers: An Umbrella Systematic Review

The aim of this umbrella systematic review is to evaluate the success rate and osseointegration of dental implants in patients with a smoking habit. Electronic database searches of PubMed/Medline, Google Scholar, ScienceDirect, Cochrane Library, and EBSCOhost were done from 2006 until August 2024, using medical subject headings (MeSH) terms. Systematic reviews and meta-analyses (SRMAs) investigating the association between smoking and the rate of success of dental implants based on dental implant failure, marginal bone loss, survival, and peri-implant parameters were deemed eligible. The Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2) was used to assess the quality of the included SRMAs. Seventeen systematic reviews have been included. In the reviews, 10 studies included meta-analyses (MAs) that evaluated implant failure rate and marginal bone loss. According to the AMSTAR 2 checklist, one review was scored "high," seven reviews were scored "moderate," seven reviews were scored "low," and two reviews were scored "critically low" quality. The strength of evidence suggests a low level of success and high rate of failure of osseointegration of dental implants in smokers. However, the influence of smoking on the rate of dental implant failure seems to be associated with various factors such as peri-implant inflammatory markers, post-operative infections, etc. Inherently, the conclusion of this review is based on a limited number of systematic reviews.

The adverse health effects of waterpipe smoking in adolescents and young adults: A narrative review

Waterpipe (WP) smoking has rapidly grown in popularity in the United States and other Western countries with the fastest uptake among younger individuals. This growth has been encouraged by the misperception that WP smoke is harmless or less harmful than cigarette smoke. To better understand how WP affects the health of young people, we conducted a narrative review of the literature focusing on the adverse health effects of WP smoking in adolescents and younger adults. We searched scientific literature databases including PubMed, MEDLINE, EMBASE, and ISI Web and selected papers that met the inclusion criteria. Sixty-three papers met the inclusion criteria and were selected for review. Data were abstracted from the selected papers into a standardized table. The evidence demonstrates that WP smoking can cause acute lung infection and injury, and carbon monoxide (CO) poisoning, in adolescents and young adults. It is also associated with adverse subclinical effects in this sub-population, including oral and systemic genotoxicity, lung function decline, and the alteration of vascular and hemodynamic functions. Limited evidence that is available indicates associations with psychological and neurological effects and asthma. No identified publications examined the association between WP use and type 2 diabetes, a condition that is associated with cigarette smoking among young people. WP smoking by younger individuals can result in their hospitalization due to systemic CO poisoning and acute lung disease, and induce subclinical adverse effects in the oral cavity, pulmonary system, and in circulation, that are involved in the pathogenesis of local and systemic chronic diseases.

Comparative Evaluation of Marginal Bone Loss and Implant Failure Rate in Smokers and Nonsmokers

Background:

Smoking impose various ill-effects on the alveolar bone concerning dental implants including reduced bone height, delayed healing of bone, poor peri-implant bone formation, increased bone loss, and peri-implantitis.

Aims:

The present clinical trial was aimed to analyze the smoking effect on dental implant survival rate as well as marginal bone loss in dental implants.

Materials and Methods:

Out of 86 patients, Group I had 43 patients who were smokers and Group II had nonsmokers. Following the implant placement, marginal bone loss radiographically and mobility were assessed clinically at 3, 6, and 12 months after implant loading.

Results:

The mean marginal loss seen in smokers at 3 months was 2.13 ± 0.21, 2.46 ± 0.09, 2.60 ± 0.0.92, and 2.74 ± 0.11 for maxillary anterior, maxillary posterior, mandibular anterior, and mandibular posterior regions, respectively. The 12-month recall visit showed a higher proportion of smokers having implant mobility. In smokers, 13.95% (n = 6) of the study participants had implant mobility, whereas 6.97% (n = 3) of the nonsmokers had mobility.

Conclusion:

Smoking is associated with long-term implant failure which is directly proportional to the duration ad frequency of smoking. Furthermore, smoking has a detrimental effect on dental implants and its surrounding bone.

Prevalence and risk indicators for peri-implant diseases: A literature review

Peri-implant diseases are known as undesirable conditions that can occur after implant therapy. Although several risk indicators are becoming clear, the causes of peri-implant diseases have not been completely investigated. The purpose of this review was to summarize the prevalence and risk indicators for peri-implant diseases by referring to current papers from various angles. Many studies have reported the varied prevalence of peri-implant mucositis (23.9%-88.0% at the patient level and 9.7%-81.0% at the implant level) and peri-implantitis (8.9%-45% at the patient level and 4.8%-23.0% at the implant level). Additionally, several studies concluded that poor oral hygiene and lack of regular maintenance were strongly correlated with the development of both peri-implant mucositis and peri-implantitis. Diabetes and a history of periodontitis were revealed as risk indicators for peri-implantitis. However, there was no definitive conclusion about the correlations between peri-implant diseases and other factors such as smoking, the shape of the implant superstructure, and the condition of the keratinized mucosa. Further studies useful for evidence-based decision-making are needed for predictable implant therapy in the long term.

In Vitro Comparison of Modes of Failures among Titanium and One- and Two-piece Zirconia Abutment under Static Load

Objectives  The objective was to assess modes of failures under static load (SL) among titanium (Ti) and one- and two-piece zirconia abutment (ZA) in vitro .

Materials and Methods  The Ti abutments were digitally scanned for the fabrication of the one- and two-piece zirconia abutment specimens. This was done to standardize the design of the one-piece abutment and make it the blueprint of the Ti abutment. Twenty-one implant abutments and 21 implant replicas were categorized into three groups as follows: group 1 (Titanium group), group 2 (one-piece ZA group), and group 3 (two-piece ZA group). A 250K-cycle, linear fatigue-load, reaching 10 to 210 Newton (N), was put on all specimens using an all-electric dynamic test instrument and the specimens were loaded until fracture.

Statistical Analysis  Assessment of mode of fracture among the groups was done visually. Significance was based below 0.05.

Results  Screw fracture ( n = 7) and abutment bending at the apical part ( n = 7) occurred in the Ti group. In the one-piece zirconia group, screw and abutment fractures occurred in seven and seven cases, respectively. In the two-piece zirconia group, screw fracture ( n = 7) above the Ti zirconia junction (transgingival segment) and abutment fracture ( n = 7) were determined as the failure modes.

Conclusion  In conclusion, all abutments underwent failures under SL in vitro ; and the mode of failure modes varied among the different abutment designs used.

Peri-implant soft tissue status and crestal bone loss around immediately-loaded narrow-diameter implants placed in cigarette-smokers: 6-year follow-up results

BACKGROUND

It is hypothesized that in the long-term, soft tissue inflammation (reflected by increased scores of peri-implant probing-depth [PD]) and crestal bone loss (CBL) is higher in cigarette-smoker than nonsmokers with narrow diameter implants (NDIs).

PURPOSE

The aim of the present 6-years' follow-up clinical observational study was to compare the peri-implant soft tissue inflammatory parameters (plaque index [PI], gingival index [GI], and PD) and CBL around immediately-loaded NDIs placed in cigarette-smokers and nonsmokers.

MATERIALS AND METHODS

In all groups, peri-implant GI, PI and PD were measured on six sites (distolingual/palatal, mesiolingual/palatal mesiobuccal, distobuccal, midlingual/palatal, and midbuccal) per implant. The CBL was gauged on digital bitewing x-rays, which were standardized using the long cone paralleling technique. CBL was demarcated as the vertical distance from 2 mm below the implant-abutment connection to the most crestally-positioned alveolar bone.

RESULTS

All study-participants were male. Twenty-six cigarette smokers and twenty-five nonsmokers were included. The mean age of cigarette-smokers and nonsmokers was 45.5 ± 10.3 and 47.4 ± 9.4 years, respectively. Cigarette-smokers had a smoking history of 10.6 ± 0.4 pack years. Family history of tobacco usage was more often reported by cigarette-smokers (57.7%) than nonsmokers (20%). All cigarette-smokers and nonsmokers were aware that smoking is a risk-factor of loss of implant. Three (11.5%) of cigarette-smokers reported that they have attempted to quit smoking and 76.9% of cigarette-smokers (n = 20) reported that they had no intention to quit smoking in the future. The peri-implant P-I (P < .01), PD (P < .01) and mesial (P < .01), and distal (P < .01) CBL were significantly high in cigarette-smokers compared with nonsmokers. There was no statistically significant difference in GI among the groups.

CONCLUSION

Cigarette-smoking enhances peri-implant soft tissue inflammation and increases CBL around immediately-loaded NDIs.