Massive destruction. That’s what I saw when I reflected my flap. The bone was decimated around the implants. “How can that be?,” Perplexed and shaken, I asked myself. Not even a year of function. Very distressing for me and my patient. What went wrong?
The patient was seen the previous week and had no pain upon presentation for his routine follow-up. He had no complaints, not a care, everything was great, loving his new smile eating everything; a new man…….. Upon examination of the recently installed prosthetics, I definitely detected purulence drainage but no bleeding and no mobility of things. Again, no pain reported by the patient. I instructed my hygienist to immediately take a full set of radiographs. To my shock and horror, severe Perimplantitis was the diagnosis. Wow, so much bone loss around those implants in comparison to last visit’s radiographs. I was speechless.
I rescheduled the patient for a surgical intervention in attempt to salvage his many implant fixtures for the following week after instituting a regimen of antibiotics and antimicrobial rinse. I contacted his M.D. to confirm no recent changes in his medical history, blood pressure and A1C ( diabetic blood marker) levels were confirmed; all just fine. I dug deeper into his faxed over medical record. Previous attempts over the years, were noted by his MD to get him to stop smoking. By default, I determined that the smoking was the only culprit which lead to the horrific state that we found ourselves in. This patient stated he was smoking about a pack a day and has for the last 40 years…….
Smoking affects people at different intensities. I have had smoker patients who have had no problems with their implants over many years since they were placed by me.
Smoking contributes to increased tissue damage and healthy bone metabolism. Nicotine may have an effect on cellular protein synthesis and impairs the wounds to heal.
The exact mechanism by which smoking compromises wound healing is unknown. Constriction of the small blood vessels in the gums and jaw bone increase in smokers resulting in a poorer quality of bone. Blood brings oxygen and nutrients to keep your bones and gum satisfied and healthy. An implant is considered to be a foreign body, essentially neither friend nor an enemy, just there. If in fact you are a smoker, your body’s ability to resist is compromised and as a result, the implant now is an enemy. The bone loss is in response to the body trying to eject this fixture via its natural defenses.
Tobacco negatively affects the outcome of almost all routine therapeutic procedures performed in the oral cavity.
In smokers, maxillary implants have more failure rate as compared to mandibular implants. Probably, maxillary bone is of lower quality and consequently more susceptible to the damaging effects of smoking. Vasoconstriction caused by the local absorption of nicotine into the bloodstream is shown to be a significant factor for implant failure by some studies. This can explain lower failure rates in the posterior mandible among smokers, since this area is covered by the tongue and hence protected against local influence of tobacco smoke.
I subsequently was able to salvage this patient’s implants. It was a long visit for both of us on that day. He has since consented to seeing his MD to start with ,”The Patch” before I commit to reconstruct and bring his smile back
I took all information from the scientific paper link below.
I just simplified it for your pleasure.
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