European Journal of Cardiovascular Medicine

With excellent survival and achievement stages, dental implants have emerged as a reliable therapy for the rehabilitation of patients who are partially or completely toothless; yet, with time, biological issues may arise. "Presence of reversible inflammatory modifications in the peri-implant mucosa without first ongoing marginal peri-implant bone loss" is the definition of peri-implant mucositis (PM), whereas "inflammation of the peri-implant soft tissue and progressive loss of supporting bone" is the definition of peri-implantitis (PI).¹

In a systematic evaluation and meta-analysis, Derks and Tomasi (2015)² demonstrated a prevalence of 22% for PI and 43% for PM. Furthermore, a cross-sectional study carried out in Spain found that the prevalence of PI and PM was 24% and 27%, respectively, at the individual stage. All of these findings, along with the unpredictable nature of PI therapy, appear to point to the critical relevance of peri-implant prevention of illness. solid proof suggests that individuals with a history of periodontitis, inadequate plaque control, and irregular post-implant treatment have a greater likelihood of developing periodontal disease (PI), according to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Situations.

There is proof that tobacco use influences the makeup of the biofilm, the host reaction, the healing of wounds, and the efficacy of periodontal therapy. It also increases the risk of periodontal disease development and progression. Similarly, some research found that smokers had a 2.7–31 times increased chance of developing PI. Also, 10-year prospective cohort research revealed that the frequency of peri-implant illnesses was 6% in non-smokers and 17.9% in smokers. According to Tsigarida et al. (2015)3, smoking affects the peri-implant microbiome, which is defined as a pathogen-rich community that is lacking in commensals even in patients with clinically significant health conditions.

Consequently, the current study set out to ascertain if smoking was linked to peri-implant illnesses in a group of patients who had received implant-supported restorations in a university dentistry clinic. Consequently, the current study set out to ascertain if smoking was linked to peri-implant illnesses in a group of patients who had received implant-supported restorations in a clinic. The study also sought to look into factors related to patients and implants that are linked to peri-implant illnesses.

This study was planned as a retrospective cohort analysis of individuals who were managed at the Dental Institute, RIMS Ranchi, in the Department of Periodontology and Implantology, using restorations supported by implants. The Ethical Committee accepted the protocol, and the study was carried out in accordance with the 1975 Declaration of Helsinki (as amended in 2013). Every patient provided written informed permission before to their involvement in the trial. Peri-implant illnesses, the primary outcome variable, served as the basis for calculating the sample size. A total of 120 participants were needed, with 40 patients in each group, assuming a 5% alpha risk. Individuals who met the following eligibility criteria were chosen : (1) individuals who were over the age of eighteen; (2) those who were partially or completely edentulous and underwent rehabilitation with dental implants; (3) those who had a complete (fixed or removable), partial, or single tooth prosthesis; (4) those who had prosthetic rehabilitation that was cemented, screwed, or via machinery maintained; and (5) those who had sufficient passage for probing within dental implants. Additionally, individuals whose medical records were partial (i.e., when more than 10% of the data was missing or incomplete) were not included in the evaluation, nor were implantation implanted between 20013 and 2023.

This study selected a representative sample of participants with implant-supported restorations performed between 2013 and 2023 using stratified random sampling depending on the year of the implant's installation. Following that, once the required number of patients in each group was reached, one examiner called the patients to invite them to come for a clinical examination.

The group being studied was split into three groups in this case: participants with peri-implant mucositis (PM), patients with peri-implantitis (PI), and healthy patients (H).

After patient files were examined, the following details about the patients were noted: age, sex, kind of edentulism, related medical conditions, and supportive periodontal therapy (SPT). Participants were split into three groups: fully compliers (i.e., participants going to the suggested SPT intervals during the observation period), unpredictable compliers (i.e., patients attending the scheduled SPT intervals irregularly), and non-compliers (i.e., subjects not attending the SPT after the active periodontal therapy). The level of SPT was defined in relation to the obedience to continuing treatment. A document that was specifically created for the research project was used to record the variables being studied for the case report.

At implant level, the following clinical parameters were evaluated at six sites per implant:

• Modified plaque index (mPI)
• Modified bleeding index (mBI)
• Suppuration on probing (SUP), assessed dichotomously within 30s after probing (i.e., presence/absence of suppuration).
• Probing pocket depth (PPD), recorded from the mucosal margin to the bottom of the peri-implant pocket.
• Mucosal recession (MR), measured from the implant neck to the mucosal margin.

Utilizing a film holder and the long-cone paralleling technique, periapical x-rays were collected. Digitally acquired radiographs were loaded into a software application and adjusted based on the implant's known dimensions. Patient files provided the initial diagnosis of periodontal disease

Smoking habit

During the clinical assessment, data regarding smoking behaviour was gathered by one examiner. Three categories were used to categorise smoking status: never smoker (less than 100 cigarettes smoked in a lifetime), former smoker, and current smoker. Additionally, smokers were categorised as light (less than 10 cigarettes per day), moderate (between 11 and 19 cigarettes per day), or heavy (more than 20 cigarettes per day). Patients were questioned regarding their exposure to tobacco smoke in terms of intake (the number of cigarettes smoked daily), duration (the number of years they smoked), and age at which they began smoking. In addition, pack-years, or lifetime exposure, were computed. Patients who had previously smoked were asked how long it had been since they stopped. The Fagerström test for nicotine dependence (FTND), a six-item assessment with a total score ranging from 0 (no dependence) to 10, was completed by smokers.

Implants

What follows characteristics of implants were gathered from patient files: use of systemic antibiotics. prior to and/or right after the operation, bone augmentation, diameter, length, brand, function time, implant location, surface roughness, type of connection, and the order of placement of implants following tooth extraction.

While continuous data points were described using the mean and standard deviation (SD), categorical ones were presented utilising frequency values and percentages. The test Kolmogorov-Smirnov was employed to determine if the data was distributed normally.

Given that 40 individuals were required in each group, 250 subjects (or about 20% of the total of 1324 patients) were chosen at random from the pool of patients. A total of 61.2% of them were willing or able to be examined, with 97 of them not being able to. The most frequent excuses for missing class were: general health (37%), geographic location (17%), lack of interest (40%), and miscellaneous (6%). Therefore, 153 patients were assessed until the minimum number of patients needed for each group was found. In addition, four patients—three with PI and one from the H group—had incomplete medical data and were thus removed from the research.

TABLE 1. Description of studied patients (n = 117) and implants (n = 450).

• Note: Bold numbers are statistically significant, p-value <.05.
• Abbreviations: CP, chronic periodontitis; PI, peri-implantitis; PM, peri-implant mucositis; SPT, supportive periodontal therapy.
• ^a Chi-square or Fisher's test.
• ^b ANOVA.

TABLE 2. Mean clinical and radiographic parameters at implant-level.

TABLE 3. Description of smoking-related variables.

TABLE 4. Random effects univariate and multinomial regression model comparing PM and PI versus peri-implant health.

• * Statistically significant, p-value <.05.
• Note: Bold numbers are statistically significant, p-value <.05.
• Abbreviations: CP, chronic periodontitis; KM, keratinized mucosa; OR, odds ratio; SPT, supportive periodontal therapy.

In a small number of individuals who were given restorations supported by implants in a department the purpose of this retrospective investigation was to ascertain the relationship among tobacco use (i.e., smoking status, lifetime cumulative dose, duration of exposure, intensity of the habit, and smoking cessation) and peri-implant diseases. The investigation also sought to determine which traits of the patient and the implant were linked to peri-implant illnesses.

While assessments among those who smoke and never-smokers and former smokers and never-smokers were made, the findings of this study first demonstrated that smoking status (i.e., smoker, former smoker, or never-smoker) was not linked to an increased risk of developing peri-implant diseases (p =.436). Diverse data have been reported before in this context.

There have been studies on PI that have not discovered a connection among tobacco and PI. ^{4, 5, 6} Despite the fact that smoking has been linked to implant disappointment, it was not identified as to be an indicator for peri-implantitis in the 2017 World Workshop Consensus Report on Periodontal and Peri-implant Conditions (Schwarz et al., 2018).⁷ The various criteria used to define a smoker (such as the amount of cigarettes smoked per day, which is a continuous variable, or whether there is a history of cigarette smoking, which is a categorical variable) could assist in clarifying some of these conflicting findings. It is noteworthy that most examinations did not report the minimum number of cigarettes smoked per day in order to be classified as a smoker.

Furthermore, there is a dearth of information on the relationship between smoking amount and peri-implant disorders, including late implant failure. In this regard, Lindquist et al. (1997)⁸ found that individuals who stated they smoked more than 14 cigarettes per day had significantly greater bone resorption than non-smokers and those who reported smoking fewer than 14 cigarettes per day in a 10-year follow-up analysis. According to Naseri et al. (2020), a systematic review and meta-analysis revealed that those who smoked more than ten cigarettes per day had a statistically significant increased chance of implant failure.⁹ These results thus indicated that an increase in daily cigarette smoking is associated with a higher likelihood of peri-implant bone loss and, consequently, failure of the implants.

It can be determined that: (a) the degree of smoke is linked to a higher risk of peri-implantitis; (b) subjects who had stopped smoking for more than 21 years may have a similar risk of peri-implant diseases compared to those who had never smoked; and (c) particular factors concerning patients and implants, such as the mean number of implants per patient, guided bone regeneration, rough surface, access to interproximal hygiene, and buccal KM dimensions, are linked to peri-implant diseases.

1. Choi, S. H., & Stommel, M. (2017). Impact of age at smoking initiation on smoking-related morbidity and all-cause mortality. American Journal of Preventive Medicine, 53(1), 33–41.
2. Derks, J., & Tomasi, C. (2015). Peri-implant health and disease. A systematic review of current epidemiology. Journal of Clinical Periodontology, 42(SUPPL 16), S158–S171.
3. Tsigarida, A. A., Dabdoub, S. M., Nagaraja, H. N., & Kumar, P. S. (2015). The influence of smoking on the peri-implant microbiome. Journal of Dental Research, 94(9), 1202–1217
4. Dalago, H. R., Schuldt Filho, G., Rodrigues, M. A. P., Renvert, S., & Bianchini, M. A. (2017). Risk indicators for peri-implantitis. A cross-sectional study with 916 implants. Clinical Oral Implants Research, 28(2), 144–150.
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7. Schwarz, F., Becker, K., Sahm, N., Horstkemper, T., Rousi, K., & Becker, J. (2017). The prevalence of peri-implant diseases for two-piece implants with an internal tube-in-tube connection: A cross-sectional analysis of 512 implants. Clinical Oral Implants Research, 28(1), 24–28.
8. Lindquist, L. W., Carlsson, G. E., & 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(10), 1667–1674.
9. Naseri, R., Yaghini, J., & Feizi, A. (2020). Levels of smoking and dental implants failure: A systematic review and meta-analysis. Journal of Clinical Periodontology, 47(4), 518–28.