Smoking and dental implants: can you have implants if you smoke?

How much does smoking raise the risk of losing an implant?

Smoking makes it roughly two and a half times more likely that an implant will be lost. The meta-analysis by Mustapha and colleagues, published in the journal Medicina in 2022, pooled the results of many studies and rests on one of the largest bodies of data on this question: across 292 publications, 35,511 implants in smokers were compared with 114,597 implants in non-smokers.

These figures do not mean that most implants in smokers are lost; in the same analysis, the great majority of those implants stayed in place. They show how much the risk rises compared with a non-smoker. The National Centre for Smoking Cessation and Training (NCSCT) in the UK also lists smoking among the factors linked to a significantly higher risk of implant failure.

The reason lies in healing. According to the NCSCT briefing for dental teams, smoking lowers the amount of oxygen in the bloodstream, which stops the tissues healing properly. Guy’s and St Thomas’ NHS Foundation Trust notes in its patient information that smokers have a higher risk of the implant failing to bond with the jawbone. For how long implants last in general, see our guide How long do dental implants last?

Does smoking also raise the risk of peri-implantitis?

Very probably, although the evidence is less clear-cut than for implant loss. In a 2024 umbrella review of meta-analyses in the Journal of Dentistry (Giok et al.), smoking was one of two factors whose link with peri-implantitis was graded as “highly suggestive”; the risk was calculated at about 2.1 times. No risk factor reached the highest level of evidence, “convincing”.

The 2023 guideline of the European Federation of Periodontology (EFP) likewise rates the evidence on smoking as less certain than that on a history of gum disease. Even so, it lists giving up or reducing smoking before implant placement among its strong recommendations for prevention.

Smoking can also mask inflammation. In the meta-analysis by Bangiev and colleagues (2025), the gums around implants bled less on probing in nicotine users than in non-smokers. The authors attribute this to the narrowing of blood vessels caused by nicotine and stress that it must not be read as a sign of health. The symptoms and treatment of inflammation are described in our guide on peri-implantitis.

How long before implant surgery should you stop smoking?

The approach most often cited in the sources is to stop at least one week before surgery and not smoke at all for the eight weeks afterwards. According to the NCSCT, patients who followed this had implant success rates comparable to non-smokers. Guy’s and St Thomas’ advises stopping and staying smoke-free in the long term.

This recommendation rests on the results of a single study; Mustapha and colleagues consider further research necessary on how smoke-free periods of different lengths around surgery affect the outcome. For treatment abroad, the timeline usually looks like this:

1. At the preliminary assessment: tell us on WhatsApp how long, how much and what you smoke (cigarettes, e-cigarettes, waterpipe).
2. Before you travel: the week before surgery is spent at home, so set your quit date so that it starts at least one week before your implant appointment.
3. During your stay and after you return: no smoking while the implant heals; the sources mention at least eight weeks, most of which falls after your flight home.
4. Afterwards: ideally stay smoke-free, because the risk continues after the implant has healed.

Support is easy to find. The NHS Better Health website offers a free Quit Smoking app and a free Personal Quit Plan, and says that with professional or expert help you are three times more likely to quit for good. Local stop smoking services in England are free, and their advisers can help you choose nicotine replacement products or other stop-smoking medicines; Wales, Scotland and Northern Ireland have their own services. Outside the UK, your GP or pharmacist can point you to similar support. How to plan your trip as a whole is explained on our page dental treatment in Türkiye.

Are e-cigarettes and waterpipes less harmful for implants?

They are considered less harmful than cigarettes, but there is no evidence that they are a safe alternative where implants are concerned. In the meta-analysis by Bangiev and colleagues (2025), which pooled nine studies:

• bone loss around implants in e-cigarette users was on average 0.83 mm greater than in non-smokers, and some inflammatory markers were also raised,
• bone loss in waterpipe smokers was on average 1.9 mm greater, although the studies varied widely,
• the authors suggest a descending order of risk from cigarettes through waterpipe and e-cigarettes to not smoking.

These results should be read with care: most of the studies measured only a single point in time and included few participants. The review by D’Ambrosio and colleagues (2022) considers it possible that e-cigarettes go with less inflammation than cigarettes, but rates the evidence as weak and found no randomised controlled trials. The 2023 EFP guideline therefore explicitly names e-cigarettes among the habits to give up before implant placement.

Are bone grafting and a sinus lift possible if you smoke?

Yes, but smoking raises the risk of these procedures too. In the systematic review by Chambrone and colleagues in Clinical Oral Implants Research, the risk of losing an implant placed in a sinus lift area was about 1.9 times higher in smokers. When only the prospective studies were analysed, the difference was not statistically significant, so the evidence is limited.

Mustapha and colleagues found about 2.9 times the odds of implant loss in the upper jaw in smokers. What a sinus lift is and when bone grafting becomes necessary are explained in our guides on sinus lift and bone grafting before implants. If such a procedure is planned, it helps to raise smoking at the preliminary assessment, so that appointments can be scheduled accordingly.

What should smokers pay attention to during implant treatment?

• Declare cigarettes, e-cigarettes, waterpipe and heated tobacco products fully at the preliminary assessment and the examination.
• Plan your quit date around the surgery date, not in the last days before you fly.
• Do not smoke while the implant or a bone graft is healing, including after you return home.
• Do not read an absence of gum bleeding as a sign of health; keep your check-ups with your dentist at home.
• Clean around the implant every day with a toothbrush and interdental brushes.
• Get support if you need it from your GP, pharmacist or a stop smoking service.

How do we plan implants for smokers at Rönesans?

At the examination in our clinic in Serdivan, we discuss your tobacco use together with your medical history. We assess the height and width of the bone with a cone-beam CT (CBCT) scan, and we carry out bone grafting and sinus lifts at our clinic. Our dentists review your case together, and you know from the start who will treat you. Before treatment starts, you receive a written treatment and cost plan that lists the treatment tooth by tooth.

You can send photos and X-rays in advance on WhatsApp to +90 532 363 49 54 or call our landline on +90 264 606 09 43. During opening hours we reply to messages in English and German within 15 minutes. After you return home, you can reach us on WhatsApp with questions and photos. Because bone loss around implants is more common in smokers, regular check-ups with your dentist at home are especially important. Our pages on aftercare and follow-up and dental implants explain more.