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Study compares effect of electronic cigarettes, cigarettes, waterpipes and smokeless tobacco on dental implants

A recent systematic review examined the effects of different nicotine-containing products on the overall health of peri-implant tissue. (Image: ZzzBlackSun/Shutterstock)

Thu. 29. August 2024

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BUDAPEST, Hungary: Smokers have been shown to have a higher chance of developing peri-implant disease. However, there is a lack of research comparing cigarettes with popular alternative products that contain nicotine in this regard. To fill the gap, a recent study has compared the effects of electronic cigarettes, waterpipes, cigarettes and smokeless tobacco on the peri-implant mucosa—the first network meta-analysis to do so. The researchers reported that e-cigarettes caused the least harm to the soft tissue around dental implants compared with the other three nicotine-containing products examined in the study.

“As a dental prosthodontic team, we have daily experience of how smoking affects peri-implant health and is linked to peri-implant disease, which is the leading cause of implant loss. The use of alternative tobacco products has increased dramatically over recent years. Recent meta-analyses have investigated the effect of waterpipes and e-cigarettes on periodontal and peri-implant parameters. However, there is a lack of comprehensive analysis comparing the effects of more types of nicotine-containing products with one another. Based on the available literature, we were able to include traditional cigarettes, e-cigarettes, waterpipes and smokeless tobacco in our analysis,” lead author Dr Orsolya Vámos from the Department of Prosthodontics at Semmelweis University in Budapest told Dental Tribune International.

According to Dr Vámos, some nicotine-containing products, such as waterpipes and smokeless tobacco, are often incorrectly perceived as less harmful than traditional cigarettes and have thus grown in popularity in recent years. To compare the effect of nicotine-containing products on peri-implant tissue, the researchers conducted a systematic review of the literature and then a network meta-analysis of the eligible 32 studies. They collected data on clinical, radiographic and immunological peri-implant parameters such as marginal bone loss, probing depth, plaque index, bleeding on probing and peri-implant sulcular fluid volume among smokers and non-smokers.

The data showed that non-smokers had the smallest marginal bone loss, whereas the majority of nicotine-containing product users had significantly higher marginal bone loss compared with non-smokers. In general, most nicotine-containing product users presented with worse peri-implant parameters compared with non-smokers. However, e-cigarette users did not show significant differences from non-smokers in many outcomes.

Dr Barbara Kispélyi, associate professor in the Department of Prosthodontics at Semmelweis University, commented that, in light of the traumatic stress and high treatment costs of implant surgery, she believes that dentists should determine whether it is advisable to proceed with implant placement or whether they should recommend against it owing to possible complications due to nicotine use, in addition to health considerations. Additionally, the researchers highlighted the importance of educating patients about the risks that any nicotine-containing product may pose to implants and about the benefits of quitting smoking and of providing them with appropriate oral health maintenance and cessation support. They also recommended that further studies should include heated tobacco products and consider factors such as the participants’ smoking habits and oral hygiene.

“By providing accurate and balanced information, dental professionals can help patients make informed choices about nicotine use and its impact on oral health. They should emphasise that alternative nicotine products are not completely risk-free and that nicotine itself remains addictive and can negatively affect oral and overall health. Periodontal disease, dry mouth and oral cancer are still associated with other nicotine-containing products. They should encourage patients to quit all forms of nicotine rather than switching from one product to another. Patients who continue to smoke should be instructed on proper at-home oral hygiene practices, and there should be a focus on regular dental check-ups,” Dr Vámos concluded.

The study, titled “The effect of nicotine-containing products on peri-implant tissues: A systematic review and network meta-analysis”, was published online on 15 April 2024 in Nicotine and Tobacco Research, ahead of inclusion in an issue.

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