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Smoking, Vaping, Marijuana, and Dental Implants

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Smoking, Vaping, Marijuana, and Dental Implants

What every dentist needs to know about risks and success rates

Dentists have been placing implants in smokers for decades, but it has never been without risk. Smoking impairs blood flow, reduces oxygen delivery, and disrupts healing at both the bone and soft tissue levels. The data is clear: Smokers experience two to three times more implant failures than nonsmokers, along with significantly higher rates of peri-implantitis and marginal bone loss. One long-term study put implant survival at 85.5 percent for smokers compared with 94.2 percent for nonsmokers. Another study found an average bone loss of 1.9 millimeters over ten years in smokers, compared to just 0.8 millimeters in nonsmokers.

Failure rates are not just theoretical. In practice, clinicians see 15 to 20 percent of implants fail in smokers, compared with less than 5 percent in nonsmokers. Early failure risk is also elevated by nearly 60 percent in smokers. That’s why many implant surgeons strongly caution their patients or even refuse to proceed without a commitment to quit during the healing period. Some require patients to sign separate smoking consent forms, making the increased risks crystal clear.

Vaping, unfortunately, is not the safer alternative patients think it is. E-cigarettes may avoid combustion, but they still deliver nicotine, which is a powerful vasoconstrictor. Studies show vaping impairs fibroblast and osteoblast function, increases inflammation, and disrupts osseointegration in much the same way as smoking. For patients who proudly announce they “only vape,” the bottom line is that their implants are still at higher risk of failure than nonsmokers.

Marijuana is less studied but equally concerning. Cannabis smoke carries many of the same combustion byproducts as tobacco, including carbon monoxide and tar, which choke oxygen delivery and compromise bone healing. Heavy marijuana users often present with xerostomia, higher rates of periodontal disease, and increased peri-implantitis. THC itself does not cause vasoconstriction like nicotine, but the smoke still inflames and stresses peri-implant tissues. Clinicians have reported more unexplained failures in heavy marijuana smokers, particularly in the first weeks after placement when patients tend to increase consumption for pain control.

The conversation becomes even more critical when we discuss surgical approach. One-stage, immediate protocols can succeed in ideal conditions, but in smokers, the odds plummet. Predictive modeling has shown survival rates of just 58.5 percent at one year and 27.6 percent at five years for smokers undergoing immediate one-stage implant placement. Compare that to a delayed, two-stage approach in nonsmokers, which yields survival rates around 97 percent at one year and 93 percent at five years. For high-risk patients, the safer bet is to bury the implant, allow protected osseointegration, and uncover several months later.

Clinically, dentists worldwide struggle with how to manage these cases. Some refuse to place implants in smokers at all, arguing their schedule is full and they don’t need the headaches. Others adopt a pragmatic stance: in certain regions, if you don’t place implants in smokers, you won’t be placing very many implants at all. Many clinicians compromise by using longer healing times, stricter consent protocols, and frank patient education: “On a nonsmoker, this works about 97 percent of the time. On you, Mr. Smoker, it drops closer to 94. Instead of a three percent failure rate, yours is six. Still good odds, but double the risk.”

Humor often creeps into these conversations. One dentist shared that his “light smoker” patient turned out to smoke whenever it was “light” outside. Others joke that heavy smokers are members of the “Church of Marlboro.” Beneath the humor is a very real challenge: balancing patient autonomy, practice philosophy, and the reality that most smokers still achieve integration, just with greater risk and less predictability.

Whether it’s cigarettes, marijuana, or vaping, the common denominator is delayed healing and reduced implant success. Most clinicians agree that counseling, consent, and case selection are the keys. For heavy smokers, burying the implant, waiting longer than the manufacturer’s recommended healing time, and using meticulous suturing for tension-free flaps can buy better odds. For all of them, encouraging even temporary cessation during the osseointegration window can make a difference.

So yes, implants can be placed in smokers, vapers, and marijuana users. But the question isn’t just “can they be placed?” It’s whether the patient fully understands the gamble they are taking with their habit and whether the clinician is willing to take on that risk.

How do you handle implant cases in smokers or vapers in your own practice? Do you refuse, delay, modify your protocols, or charge differently, and has your approach changed after experiencing failures?

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October 2025
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