OJST  Vol.4 No.3 , March 2014
The Effects of Smoking on Periodontal Therapy: An Evidence-Based Comprehensive Literature Review
The positive relationship between smoking and major general health diseases such as cancer, cardiovascular disease, pulmonary disease and negative pregnancy outcomes is already established. Moreover, the association between smoking as a major environmental risk factor for periodontal disease has also been established. Smoking is considered to have negative adverse effect on periodontal therapy ranging from non-surgical treatment, periodontal surgery, regenerative procedures and implants. This review article will attempt to build on previous studies in the periodontal literature in order to present an evidence-based comprehensive literature review on the effects of smoking on periodontal therapy.

Cite this paper
Abu-Ta’a, M. (2014) The Effects of Smoking on Periodontal Therapy: An Evidence-Based Comprehensive Literature Review. Open Journal of Stomatology, 4, 143-151. doi: 10.4236/ojst.2014.43022.
[1]   Labriola, A., Needleman, I. and Moles, D.R. (2005) Systematic Review of the Effect of Smoking on Nonsurgical Periodontal Therapy. Periodontology, 37, 124-137.

[2]   Haber, J., Wattles, J., Crowley, M., Mandell, R., Joshipura, K. and Kent, R.L. (1993) Evidence for Cigarette Smoking as a Major Risk Factor for Periodontitis. Journal of Periodontology, 64, 16-23.

[3]   Sgolastra, F., Petrucci, A., Severino, M., Gatto, R. and Monaco, A. (2014) Smoking and the Risk of Peri-Implantitis. A Systematic Review and Meta-Analysis. Clinical Oral Implants Research.

[4]   Chambrone, L., Preshaw, P.M., Ferreira, J.D., Rodrigues, J.A., Cassoni, A. and Shibli, J.A. (2014) Effects of Tobacco Smoking on the Survival Rate of Dental Implants Placed in Areas of Maxillary Sinus Floor Augmentation: A Systematic Review. Clinical Oral Implants Research, 4, 408-416.

[5]   Grossi, S.G., Genco, R.J., Machtei, E.E., Ho, A.W., Koch, G., Dunford, R., Zambon, J.J. and Hausmann, E. (1995) Assessment of Risk for Periodontal Disease. II. Risk Indicators for Alveolar Bone Loss. Journal of Periodontology, 66, 23-29.

[6]   Hayman, L., Steffen, M.J., Stevens, J., Badger, E., Tempro, P., Fuller, B., McGuire, A., Al-Sabbagh, M., Thomas, M. V. and Ebersole, J.L. (2011) Smoking and Periodontal Disease: Discrimination of Antibody Responses to Pathogenic and Commensal Oral Bacteria. Clinical & Experimental Immunology, 1, 118-126.

[7]   Scott, D.A., Palmer, R.M. and Stapleton, J.A. (2001) Dose-Years as an Improved Index of Cumulative Tobacco Smoke Exposure. Medical Hypotheses, 56, 735-736.

[8]   Molloy, J., Wolff, L.F., Lopez-Guzman, A. and Hodges, J.S. (2004) The Association of Periodontal Disease Parameters with Systemic Medical Conditions and Tobacco Use. Journal of Clinical Periodontology, 31, 625-632.

[9]   Persson, R.E., Kiyak, A.H., Wyatt, C.C., Macentee, M. and Persson, G.R. (2005) Smoking, a Weak Predictor of Periodontitis in Older Adults. Journal of Clinical Periodontology, 32, 512-517.

[10]   Kaldahl, W.B., Johnson, G.K., Patil, K.D. and Kalkwarf, K.L. (1996) Levels of Cigarette Consumption and Response to Periodontal Therapy. Journal of Periodontology, 67, 675-681.

[11]   Grossi, S.G., Zambon, J., Machtei, E.E., Schifferle, R., Andreana, S., Genco, R.J., Cummins, D. and Harrap, G. (1997) Effects of Smoking and Smoking Cessation on Healing after Mechanical Periodontal Therapy. Journal of the American Dental Association, 128, 599-607.

[12]   Stokholm, R., Isidor, F. and Nyengaard, J.R. (2013) Histologic and Histomorphometric Evaluation of Peri-Implant Bone of Immediate or Delayed Occlusal-Loaded Non-Splinted Implants in the Posterior Mandible—An Experimental Study in Monkeys. Clinical Oral Implants Research.

[13]   Pellicer-Chover, H., Via-Almunia, J., Romero-Millán, J., Pearrocha-Oltra, D., García-Mira, B. and Pearrocha-Diago, M. (2013) Influence of Occlusal Loading on Peri-Implant Clinical Parameters. A Pilot Study. Clinical Oral Implants Research.

[14]   Quirynen, M., Naert, I. and van, S.D. (1992) Fixture Design and Overload Influence Marginal Bone Loss and Fixture Success in the Branemark System. Clinical Oral Implants Research, 3, 104-111.

[15]   Levin, L. and Kessler-Baruch, O. (2013) Cigarette Smoking and the Alveolar Bone around Teeth and Dental Implants. Review. New York State Dental Journal, 5, 53-59.

[16]   Alsaadi, G., Quirynen, M., Michiles, K., Teughels, W., Komarek, A. and van, S. D. (2008) Impact of Local and Systemic Factors on the Incidence of Failures up to Abutment Connection with Modified Surface Oral Implants. Journal of Clinical Periodontology, 35, 51-57.

[17]   Haber, J. and Kent, R.L. (1992) Cigarette Smoking in a Periodontal Practice. Journal of Periodontology, 63, 100-106.

[18]   Mongardini, C., van, S.D., Dekeyser, C. and Quirynen, M. (1999) One Stage Full-versus Partial-Mouth Disinfection in the Treatment of Chronic Adult or Generalized Early-Onset Periodontitis. I. Long-Term Clinical Observations. Journal of Periodontology, 70, 632-645.

[19]   Palmer, R.M., Scott, D.A., Meekin, T.N., Poston, R.N., Odell, E.W. and Wilson, R.F. (1999) Potential Mechanisms of Susceptibility to Periodontitis in Tobacco Smokers. Journal of Periodontal Research, 34, 363-369.

[20]   Bizzarro, S., Loos, B.G., Laine, M.L., Crielaard, W. and Zaura, E. (2013) Subgingival Microbiome in Smokers and Non-Smokers in Periodontitis: An Exploratory Study Using Traditional Targeted Techniques and a Next-Generation Sequencing. Journal of Clinical Periodontology, 5, 483-492.

[21]   Matthews, C.R., Joshi, V., de Jager, M., Aspiras, M. and Kumar, P.S. (2013) Host-Bacterial Interactions during Induction and Resolution of Experimental Gingivitis in Current Smokers. Journal of Periodontology, 1, 32-40.

[22]   Renvert, S., Dahlen, G. and Wikstrom, M. (1998) The Clinical and Microbiological Effects of Non-Surgical Periodontal Therapy in Smokers and Non-Smokers. Journal of Clinical Periodontology, 25, 153-157.

[23]   Ryder, M.I., Pons, B., Adams, D., Beiswanger, B., Blanco, V., Bogle, G., Donly, K., Hallmon, W., Hancock, E.B., Hanes, P., Hawley, C., Johnson, L., Wang, H.L., Wolinsky, L., Yukna, R., Polson, A., Carron, G. and Garrett, S. (1999) Effects of Smoking on Local Delivery of Controlled-Release Doxycycline as Compared to Scaling and Root Planing. Journal of Clinical Periodontology, 26, 683-691.

[24]   Williams, R.C., Paquette, D.W., Offenbacher, S., Adams, D.F., Armitage, G.C., Bray, K., Caton, J., Cochran, D.L., Drisko, C.H., Fiorellini, J.P., Giannobile, W.V., Grossi, S., Guerrero, D.M., Johnson, G.K., Lamster, I.B., Magnusson, I., Oringer, R.J., Persson, G.R., Van Dyke, T.E., Wolff, L.F., Santucci, E.A., Rodda, B.E. and Lessem, J. (2001) Treatment of Periodontitis by Local Administration of Minocycline Microspheres: A Controlled Trial. Journal of Periodontology, 72, 1535-1544.

[25]   Jin, L., Wong, K.Y., Leung, W.K. and Corbet, E.F. (2000) Comparison of Treatment Response Patterns Following Scaling and Root Planing in Smokers and Non-Smokers with Untreated Adult Periodontitis. Journal of Clinical Dentistry, 11, 35-41.

[26]   Apatzidou, D.A., Riggio, M.P. and Kinane, D.F. (2005) Impact of Smoking on the Clinical, Microbiological and Immunological Parameters of Adult Patients with Periodontitis. Journal of Clinical Periodontology, 32, 973-983.

[27]   Darby, I.B., Hodge, P.J., Riggio, M.P. and Kinane, D.F. (2005) Clinical and Microbiological Effect of Scaling and Root Planing in Smoker and Non-Smoker Chronic and Aggressive Periodontitis Patients. Journal of Clinical Periodontology, 32, 200-206.

[28]   Guarnelli, M.E., Farina, R., Cucchi, A. and Trombelli, L. (2010) Clinical and Microbiological Effects of Mechanical Instrumentation and Local Antimicrobials during Periodontal Supportive Therapy in Aggressive Periodontitis Patients: Smoker versus Non-Smoker Patients. Journal of Clinical Periodontology, 11, 998-1004.

[29]   Preber, H. and Bergstrom, J. (1990) Effect of Cigarette Smoking on Periodontal Healing Following Surgical Therapy. Journal of Clinical Periodontology, 17, 324-328.

[30]   Scabbia, A., Cho, K.S., Sigurdsson, T.J., Kim, C.K. and Trombelli, L. (2001) Cigarette Smoking Negatively Affects Healing Response Following Flap Debridement Surgery. Journal of Periodontology, 72, 43-49.

[31]   Trombelli, L., Cho, K.S., Kim, C.K., Scapoli, C. and Scabbia, A. (2003) Impaired Healing Response of Periodontal Furcation Defects Following Flap Debridement Surgery in Smokers. A Controlled Clinical Trial. Journal of Clinical Periodontology, 30, 81-87.

[32]   Zucchelli, G., Mounssif, I., Mazzotti, C., Stefanini, M., Marzadori, M., Petracci, E. and Montebugnoli, L. (2014) Coronally Advanced Flap with and without Connective Tissue Graft for the Treatment of Multiple Gingival Recessions: A Comparative Short- and Long-Term Controlled Randomized Clinical Trial. Journal of Clinical Periodontology, 41, 396-403.

[33]   Harris, R.J., Miller, L.H., Harris, C.R. and Miller, R.J. (2005) A Comparison of Three Techniques to Obtain Root Coverage on Mandibular Incisors. Journal of Periodontology, 76, 1758-1767.

[34]   Nanavati, B., Bhavsar, N. and Jaydeepchandra, M. (2013) Coronally Positioned Flap for Root Coverage: Comparison between Smokers and Nonsmokers. Review. Journal of International Oral Health, 5, 21-27.

[35]   Erley, K.J., Swiec, G.D., Herold, R., Bisch, F.C. and Peacock, M.E. (2006) Gingival Recession Treatment with Connective Tissue Grafts in Smokers and Non-Smokers. Journal of Periodontology, 77, 1148-1155.

[36]   Silva, C.O., Sallum, A.W., de Lima, A.F. and Tatakis, D.N. (2006) Coronally Positioned Flap for Root Coverage: Poorer Outcomes in Smokers. Journal of Periodontology, 77, 81-87.

[37]   Trombelli, L. and Scabbia, A. (1997) Healing Response of Gingival Recession Defects Following Guided Tissue Regeneration Procedures in Smokers and Non-Smokers. Journal of Clinical Periodontology, 24, 529-533.

[38]   Amarante, E.S., Leknes, K.N., Skavland, J. and Lie, T. (2000) Coronally Positioned Flap Procedures with or without a Bioabsorbable Membrane in the Treatment of Human Gingival Recession. Journal of Periodontology, 71, 989-998.

[39]   Rosen, P.S., Bowers, G.M. and Marks, M.H. (1996) Modifications of the Subpedicle Connective Tissue Graft Technique: A Predictable Procedure for Covering Exposed Roots. Compendium of Continuing Education in Dentistry, 17, 440-442,444.

[40]   Needleman, I.G., Worthington, H.V., Giedrys-Leeper, E. and Tucker, R.J. (2006) Guided Tissue Regeneration for Periodontal Infra-Bony Defects. Cochrane Database of Systematic Reviews, 2, Article ID: CD001724.

[41]   Cortellini, P., Pini, P.G. and Tonetti, M.S. (1996) Periodontal Regeneration of Human Intrabony Defects with Bioresorbable Membranes. A Controlled Clinical Trial. Journal of Periodontology, 67, 217-223.

[42]   Loos, B.G., Louwerse, P.H., Van Winkelhoff, A.J., Burger, W., Gilijamse, M., Hart, A.A. and Van Der Velden, U. (2002) Use of Barrier Membranes and Systemic Antibiotics in the Treatment of Intraosseous Defects. Journal of Clinical Periodontology, 29, 910-921.

[43]   Stavropoulos, A., Mardas, N., Herrero, F. and Karring, T. (2004) Smoking Affects the Outcome of Guided Tissue Regeneration with Bioresorbable Membranes: A Retrospective Analysis of Intrabony Defects. Journal of Clinical Periodontology, 31, 945-950.

[44]   Luepke, P.G., Mellonig, J.T. and Brunsvold, M.A. (1997) A Clinical Evaluation of a Bioresorbable Barrier with and without Decalcified Freeze-Dried Bone Allograft in the Treatment of Molar Furcations. Journal of Clinical Periodontology, 24, 440-446.

[45]   Bowers, G.M., Schallhorn, R.G., McClain, P.K., Morrison, G.M., Morgan, R. and Reynolds, M.A. (2003) Factors Influencing the Outcome of Regenerative Therapy in Mandibular Class II Furcations: Part I. Journal of Periodontology, 74, 1255-1268.

[46]   Tsao, Y.P., Neiva, R., Al-Shammari, K., Oh, T.J. and Wang, H.L. (2006) Factors Influencing Treatment Outcomes in Mandibular Class II Furcation Defects. Journal of Periodontology, 77, 641-646.

[47]   Cortellini, P. and Tonetti, M.S. (2004) Long-Term Tooth Survival Following Regenerative Treatment of Intrabony Defects. Journal of Periodontology, 75, 672-678.

[48]   Bain, C.A. (2003) Implant Installation in the Smoking Patient. Periodontology, 33, 185-193.

[49]   Gorman, L.M., Lambert, P.M., Morris, H.F., Ochi, S. and Winkler, S. (1994) The Effect of Smoking on Implant Survival at Second-Stage Surgery: DICRG Interim Report No. 5. Dental Implant Clinical Research Group. Implant Dentistry, 3, 165-168.

[50]   Lambert, P.M., Morris, H.F. and Ochi, S. (2000) The Influence of Smoking on 3-Year Clinical Success of Osseointegrated Dental Implants. Annals of Periodontology, 5, 79-89.

[51]   Wallace, R.H. (2000) The Relationship between Cigarette Smoking and Dental Implant Failure. European Journal of Prosthodontics and Restorative Dentistry, 8, 103-106.

[52]   Chuang, S.K., Wei, L.J., Douglass, C.W. and Dodson, T.B. (2002) Risk Factors for Dental Implant Failure: A Strategy for the Analysis of Clustered Failure-Time Observations. Journal of Dental Research, 81, 572-577.

[53]   Lindquist, L.W., Carlsson, G.E. and Jemt, T. (1996) A Prospective 15-Year Follow-Up Study of Mandibular Fixed Prostheses Supported by Osseointegrated Implants. Clinical Results and Marginal Bone Loss. Clinical Oral Implants Research, 7, 329-336.

[54]   Lindquist, L.W., Carlsson, G.E. and Jemt, T. (1997) Association between Marginal Bone Loss around Osseointegrated Mandibular Implants and Smoking Habits: A 10-Year Follow-Up Study. Journal of Dental Research, 76, 1667-1674.

[55]   Levin, L., Sadet, P. and Grossmann, Y. (2006) A Retrospective Evaluation of 1,387 Single-Tooth Implants: A 6-Year Follow-Up. Journal of Periodontology, 77, 2080-2083.

[56]   Wagenberg, B. and Froum, S.J. (2006) A Retrospective Study of 1925 Consecutively Placed Immediate Implants from 1988 to 2004. International Journal of Oral & Maxillofacial Implants, 21, 71-80.

[57]   Kumar, A., Jaffin, R.A. and Berman, C. (2002) The Effect of Smoking on Achieving Osseointegration of Surface-Modified Implants: A Clinical Report. International Journal of Oral & Maxillofacial Implants, 17, 816-819.

[58]   Shimpuku, H., Nosaka, Y., Kawamura, T., Tachi, Y., Shinohara, M. and Ohura, K. (2003) Genetic Polymorphisms of the Interleukin-1 Gene and Early Marginal Bone Loss around Endosseous Dental Implants. Clinical Oral Implants Research, 14, 423-429.

[59]   Penarrocha, M., Palomar, M., Sanchis, J.M., Guarinos, J. and Balaguer, J. (2004) Radiologic Study of Marginal Bone Loss around 108 Dental Implants and Its Relationship to Smoking, Implant Location, and Morphology. International Journal of Oral & Maxillofacial Implants, 19, 861-867.

[60]   Wennstrom, J., Zurdo, J., Karlsson, S., Ekestubbe, A., Grondahl, K. and Lindhe, J. (2004) Bone Level Change at Implant-Supported Fixed Partial Dentures with and without Cantilever Extension after 5 Years in Function. Journal of Clinical Periodontology, 31, 1077-1083.

[61]   Mundt, T., Mack, F., Schwahn, C. and Biffar, R. (2006) Private Practice Results of Screw-Type Tapered Implants: Survival and Evaluation of Risk Factors. International Journal of Oral & Maxillofacial Implants, 21, 607-614.

[62]   Roos-Jansaker, A.M., Lindahl, C., Renvert, H. and Renvert, S. (2006) Nine- to Fourteen-Year Follow-Up of Implant Treatment. Part I: Implant Loss and Associations to Various Factors. Journal of Clinical Periodontology, 33, 283-289.

[63]   Bain, C.A., Weng, D., Meltzer, A., Kohles, S.S. and Stach, R.M. (2002) A Meta-Analysis Evaluating the Risk for Implant Failure in Patients Who Smoke. Compendium of Continuing Education in Dentistry, 23, 695-699,702,704.

[64]   Geurs, N.C., Wang, I.C., Shulman, L.B. and Jeffcoat, M.K. (2001) Retrospective Radiographic Analysis of Sinus Graft and Implant Placement Procedures from the Academy of Osseointegration Consensus Conference on Sinus Grafts. International Journal of Periodontics & Restorative Dentistry, 21, 517-523.

[65]   Galindo-Moreno, P., Fernández-Jiménez, A., O’Valle, F., Silvestre, F.J., Sánchez-Fernández, E., Monje, A. and Catena, A. (2013) Marginal Bone Loss in Implants Placed in Grafted Maxillary Sinus. Clinical Implant Dentistry and Related Research.

[66]   Woo, V.V., Chuang, S.K., Daher, S., Muftu, A. and Dodson, T.B. (2004) Dentoalveolar Reconstructive Procedures as a Risk Factor for Implant Failure. Journal of Oral and Maxillofacial Surgery, 62, 773-780.

[67]   Levin, L., Herzberg, R., Dolev, E. and Schwartz-Arad, D. (2004) Smoking and Complications of Onlay Bone Grafts and Sinus Lift Operations. International Journal of Oral & Maxillofacial Implants, 19, 369-373.

[68]   Paquette, D., Oringer, R., Lessem, J., Offenbacher, S., Genco, R., Persson, G.R., Santucci, E.A. and Williams, R.C. (2003) Locally Delivered Minocycline Microspheres for the Treatment of Periodontitis in Smokers. Journal of Clinical Periodontology, 30, 787-794.

[69]   Tomasi, C. and Wennstrom, J.L. (2004) Locally Delivered Doxycycline Improves the Healing Following Non-Surgical Periodontal Therapy in Smokers. Journal of Clinical Periodontology, 31, 589-595.

[70]   Winkel, E.G., Van Winkelhoff, A.J., Timmerman, M.F., Van der Velden, U. and Van der Weijden, G.A. (2001) Amoxicillin Plus Metronidazole in the Treatment of Adult Periodontitis Patients. A Double-Blind Placebo-Controlled Study. Journal of Clinical Periodontology, 28, 296-305.

[71]   Tipton, D.A. and Dabbous, M.K. (1995) Effects of Nicotine on Proliferation and Extracellular Matrix Production of Human Gingival Fibroblasts in Vitro. Journal of Periodontology, 66, 1056-1064.

[72]   Soder, B., Nedlich, U. and Jin, L.J. (1999) Longitudinal Effect of Non-Surgical Treatment and Systemic Metronidazole for 1 Week in Smokers and Non-Smokers with Refractory Periodontitis: A 5-Year Study. Journal of Periodontology, 70, 761-771.

[73]   Akamatsu, H., Kurokawa, I., Nishijima, S. and Asada, Y. (1992) Inhibition of Neutrophil Chemotactic Factor Production in Comedonal Bacteria by Subminimal Inhibitory Concentrations of Erythromycin. Dermatology, 185, 41-43.

[74]   Matesanz-Pérez, P., García-Gargallo, M., Figuero, E., Bascones-Martínez, A., Sanz, M. and Herrera D. (2013) A Systematic Review on the Effects of Local Antimicrobials as Adjuncts to Subgingival Debridement, Compared with Subgingival Debridement Alone, in the Treatment of Chronic Periodontitis. Journal of Clinical Periodontology, 40, 227-241.

[75]   Golub, L.M., Lee, H.M., Ryan, M.E., Giannobile, W.V., Payne, J. and Sorsa, T. (1998) Tetracyclines Inhibit Connective Tissue Breakdown by Multiple Non-Antimicrobial Mechanisms. Advances in Dental Research, 12, 12-26.