Dental Publication / Article Details |
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Healing in Smokers Versus Nonsmokers: Survival Rates for Sinus Floor Augmentation with Simultaneous Implant Placement
Author(s):
Ziv Mazor, DMD;Michael Peleg, DMD;Arun K. Garg, DMD
Date Added:
4/1/2010
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Summary:
Evidence suggests that smoking is detrimental to the survival of dental implants placed in grafted maxillary sinuses. Studies have shown that improving bone quantity and quality, using rough- surfaced implants, and practicing good oral hygiene may improve outcomes. In this prospective study, the long-term survival rates of implants placed simultaneously with sinus grafting in smokers and non- smokers were compared. Materials and Methods: Implants with roughened surfaces were immedi- ately placed into maxillary sinus grafts in patients with 1 to 7 mm of residual bone. A total of 2,132 simultaneous implants were placed into the grafted sinuses of 226 smokers (627 implants) and 505 nonsmokers (1,505 implants). A majority of the patients received a composite graft consisting of 50% autogenous bone. In both smokers and nonsmokers, approximately two thirds of the implants had
microtextured surfaces; the remainder had hydroxyapatite-coated surfaces. The implants were restored and monitored during clinical follow-up for up to 9 years. Results: Cumulative survival of implants at 9 years was 97.9%. There were no statistically significant differences in implant failure rates between smokers and nonsmokers. Discussion: Implant survival was believed to depend on the following aspects of the technique used: creation of a large buccal window to allow access to a large recipient site; use of composite grafts consisting of at least 50% autogenous bone; meticulous bone condensation; placement of long implants (ie, 15 mm); use of implants with hydroxyapatite-coated or microtextured surfaces; use of a membrane to cover the graft and implants; antibiotic use and strict oral hygiene; use of interim implants and restricted use of dentures; and adherence to a smoking ces- sation protocol.
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