Effects of tobacco smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation: A systematic review

Objectives: The objective of this systematic review was to evaluate the effects of smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation. Material and methods: The Cochrane Oral Health Group's Trials Register (CENTRAL), MEDLINE and EMBASE were searched in duplicate up to, and including, October 2012 without language restrictions. Studies were considered eligible for inclusion if they involved the treatment of smokers and non-smokers with titanium implants and sinus floor elevation procedures. The Newcastle-Ottawa Scale and the Cochrane Collaboration's quality assessment tool were used for the assessment of the risk of bias in included studies. Random effects meta-analyses were used to assess the number of implants lost in smokers vs. number of implants lost in non-smokers. Results: Of 3360 potentially eligible papers, eight studies were included. More than half (62.5%) of the studies found that smoking adversely affects implant survival in sites of sinus floor augmentation. Similarly, the pooled analysis indicated a statistically significantly increased risk of implant failure in smokers when the outcomes of all studies available to be included into meta-analysis were evaluated [RR: 1.87 (95% CI: 1.35, 2.58), P = 0.0001]. Conversely, a subgroup analysis including only prospective studies (3 studies) did not reveal significant differences in implant failure between smokers and non-smokers [RR: 1.55 (95% CI: 0.91, 2.65), P = 0.11]. Conclusions: Although smoking was associated with implant failure in most of individual studies and in the overall meta-analysis, the detrimental effect of smoking was not confirmed when only prospective data were assessed.