We don't refuse to treat smokers, but we won't pretend smoking doesn't matter either. Here's the real picture — what the research shows, what we can do to optimize outcomes, and what the trade-offs look like.
Smoking elevates implant failure risk, but doesn’t disqualify you. We discuss real numbers honestly during consultation.
Schedule Free ConsultationThe clinical research on smoking and dental implants is consistent and well-established. Smoking affects implants in several specific ways — not vague concerns, but measurable biological effects with predictable consequences for implant survival.
Nicotine is a vasoconstrictor: it narrows blood vessels and reduces blood flow to tissues, which means slower bone healing and a higher risk that the implant fails to integrate. Smoking also suppresses key components of the immune system that fight bacterial infection, putting implants at significantly higher risk of peri-implantitis (infection-related bone loss). And osseointegration — the foundation of implant success — proceeds more slowly and reaches lower maximum bone-to-implant contact in smokers.
Multiple long-term studies show implant failure rates 2–3× higher in heavy smokers compared to non-smokers, with the difference particularly pronounced in the upper jaw. These are facts. Pretending otherwise wouldn’t serve any patient.
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Patients deserve real numbers, not vague warnings. Here’s what published outcomes look like at 5 years — with the caveat that ranges vary by study, jaw location, implant location, and other factors.
Implant success rate at 5 years: roughly 95–98%. This is the figure most implant marketing references — and it’s accurate, but only for non-smokers.
Implant success rate at 5 years: roughly 85–92%. The majority of cases still succeed, but the failure rate is meaningfully higher than for non-smokers.
Implant success rate at 5 years: roughly 80–87%. Most heavy smokers still see successful long-term implants, but the elevated failure risk is real, and the cost of failure (replacement procedures, additional surgery) is real.
Smoking-related failure rates are highest in the upper jaw, where bone is softer and the maxillary sinus complicates surgical anatomy. Smokers needing upper-arch implant treatment have meaningfully different risk profiles than those needing lower-arch work.
We don't refuse to treat smokers, but we do ask for specific commitments that meaningfully reduce risk. Even temporary cessation 2–3 weeks before surgery and 6–8 weeks afterward significantly improves outcomes. We provide referral to cessation programs and support for patients willing to attempt this.
We understand many patients can't or won't quit, and we proceed with treatment for those patients with full disclosure of the additional risk. When full cessation isn't realistic, even reducing daily cigarette count during the 2-week window around surgery measurably improves healing outcomes.
Smokers face higher peri-implantitis risk, so daily brushing, flossing around implants, and use of antimicrobial rinses become non-negotiable — and we typically recommend professional cleanings every 3–4 months instead of every 6 for early detection of peri-implant issues.
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There are specific combinations of factors where, in good conscience, we'd recommend against proceeding with implants until something changes.
The combination of ongoing heavy smoking and severe bone loss compounds risk significantly. For these patients, we may recommend prosthetic alternatives or postponing implant treatment until smoking can be reduced.
Both conditions impair healing. Together, the risk of implant failure becomes high enough that we typically recommend addressing one or both before implant treatment.
Patients who can't or won't reduce smoking even temporarily around surgery face the highest failure risk. We have honest conversations with these patients about whether implant treatment is the right choice now.
A patient who has already had implants fail and continues to smoke heavily faces a high probability of recurrent failure. We discuss whether further attempts make sense.
We don't pressure patients to quit. We do make resources available for patients interested in attempting cessation. The decision is yours.
Each links to deeper detail on a treatment option or related risk-factor situation discussed above.
