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A meta-analysis evaluating the risk for implant failure in patients who smoke

Bain CA, Weng D, Meltzer A, Kohles SS, Stach RM . Compend Contin Educ Dent. 2002;23(8):695-9, 702, 704 passim; quiz 708

Failure of dental implants to achieve osseointegration is often attributed to patient baseline variables, such as smoking. This meta-analysis examines outcomes of clinical studies that monitored the performance of machined-surfaced and Osseotite, implants; the analysis also isolates the effect of smoking. The implant data for the machined-surfaced implants are derived from three prospective multicenter studies (n = 2,614) and from six prospective studies (n = 2,274) for the Osseotite implants. All implant placement surgeries followed a two-stage surgical approach with an unloaded healing period of 4 to 6 months. An evaluation of the data sets (i.e., smokers vs nonsmokers) was first performed to determine the existence of imbalance in baseline variables, including patient demographics, bone quality, location, dimensions, and types of prostheses. Analysis of the distributions of these baseline variables showed similar proportionalities and therefore qualified the data sets for comparison of the cumulative success rates (CSR) of the implants on the basis of smoking. For the 2,117 nonsmoking, machined-surfaced implants, the 3-year CSR is 92.8%; for the 492 implants in the smoking group, the CSR is 93.5%. The 3-year CSR for 1,877 nonsmoking Osseotite implants is 98.4%; for the 397 smoking implants it is 98.7%. No difference is observed between the smoking groups and the nonsmoking groups in these patient populations. There is, however, a clinically relevant difference observed between the two implant types.