Dental Implants for Smokers

Smoking roughly doubles the implant failure rate. Non-smokers see 2–5% 10-year failure rates; smokers see 6–11% in the same time window. Heavy smokers (more than a pack a day) see worse than that.

The risk is highest in the first 3 months when the bone is integrating to the implant. Smokers fail at this integration stage about 2–3x more than non-smokers. Late peri-implantitis risk is also elevated, roughly 2x, over the long run.

That said: many smokers have successful implants. We accept smoking patients with a frank conversation about the risk and a strong push to quit around surgery.

Nicotine constricts blood vessels at the surgical site. The bone-implant bond requires oxygen, nutrients, and growth factors delivered through those blood vessels. Reduced delivery means slower and less complete integration.

Smoke also disrupts the soft-tissue seal between the gum and the implant abutment, allowing bacteria to penetrate the implant-bone interface. This drives the elevated long-term peri-implantitis risk.

Vaping appears similarly disruptive based on current evidence — the nicotine vasoconstriction is the same, and some vape compounds cause additional soft-tissue inflammation. We treat vaping the same as smoking around implant surgery.

Stop smoking two weeks before surgery and eight weeks after. That ten-week window covers the highest- risk integration period. Patients who can do this see failure rates close to non-smoker baseline.

Nicotine replacement (patches, gum, lozenges) carries the same vasoconstriction risk and we recommend abstinence rather than substitution during the window. After Week 10, you can return to whatever nicotine pattern you choose.

If you cannot stop entirely, cutting consumption in half during the window still reduces failure risk measurably. We document this realistically in the consent process.

We still place implants on patients who continue to smoke through the integration period. The conversation is about expected outcomes — your failure risk is roughly double the non-smoker baseline, and we want you to make the choice with eyes open.

For active smokers, we sometimes recommend overengineering: using slightly larger implants for better initial stability, extending the integration period from 12 weeks to 16 weeks, and being more aggressive about hygiene follow-up.

For full-arch cases (All-on-6) in active smokers, success rates are still 85–90% in our experience. The six-implant geometry gives more margin for the smoking-related risk than a four-implant design would, which is one of several reasons we standardize on All-on-6. The math usually still works compared to staying in dentures.

For smokers who get past the integration period, the long-term risk is peri-implantitis. The biggest single thing you can do to protect your implants long-term is meticulous daily hygiene and twice-yearly professional cleanings.

We see smoking implant patients three times a year instead of two, and we are more aggressive about intervening at any sign of early peri-implantitis. Catching it at the gum-inflammation stage means it is treatable; catching it at the bone-loss stage means the implant is often unrecoverable.

Many of our smoking patients tell us that the implant project was the push they needed to quit. The two-week pre-surgery window, the conversation about long-term risk, and a real reason to make it stick.

We don't lecture, and we don't refuse care over smoking. We do put the numbers in front of you so you can make an informed decision. That's what the free consult is for.