If you smoke and are considering dental implants, you have probably been told it is a problem without being told exactly why. It is a fair question, and the answer is more useful than a warning.
Dr. Jin-Ho Cho at Shine Dental Newington — BDS (University of Sydney, 1987), more than 35 years in practice, over 9,000 implant fixtures placed — discusses smoking openly at consultation, because it changes the odds and sometimes the plan. It does not automatically rule treatment out.
Why does smoking affect implants specifically?
An implant works by fusing with bone, a process called osseointegration. That fusion depends on a good blood supply delivering oxygen and the cells that build bone.
Nicotine narrows small blood vessels, reducing flow to the gum and bone at exactly the site that needs it. Carbon monoxide in smoke reduces how much oxygen the blood carries. Heat and chemical irritation affect the gum tissue directly. Smoking also impairs the immune response, which matters when a surgical site is healing.
The result is that the same surgery, performed the same way, heals in a less favourable environment. This is not a moral point — it is circulation and oxygen.
How much does it actually change the odds?
Published research consistently reports higher implant failure rates in smokers than non-smokers. The size of the difference varies between studies and depends on how heavily someone smokes, the site in the mouth, and whether grafting was involved. Upper jaw sites and grafted sites tend to show the difference more sharply.
What that means in practice: implants in smokers do succeed, frequently. But across a group of patients, more of them fail than in a comparable group of non-smokers. Your own outcome cannot be predicted from a statistic — it can only be assessed from your circumstances.
Two other effects are worth knowing. Smoking increases the risk of early healing complications after surgery, including problems at the wound site. And it raises the risk of peri-implantitis later, the gum and bone inflammation around an established implant that is the main cause of late implant loss.
Does vaping make a difference?
There is far less long-term research on vaping and implants than on cigarettes, and it would be overstating the evidence to claim a clear picture. Nicotine has the same vascular effect regardless of how it is delivered, so nicotine-containing vapes are not a neutral substitute from a healing standpoint. Where this matters for your case, it is worth raising at consultation rather than assuming either way.
Should I stop, and when?
Stopping helps, and stopping around the surgical period helps most. The healing window — the weeks after placement and the months of integration — is when blood supply and immune function matter most.
Many clinicians suggest stopping in the period before surgery and continuing through healing. Whether that becomes permanent is your decision, but the treatment has the best chance in a period without smoking around it. Even reducing helps; the effect is dose-related rather than all-or-nothing.
If you want support with quitting, your GP can discuss options, and the Quitline service is available across Australia. This is a general observation rather than medical advice for your situation.
Will a dentist refuse to treat me?
Not usually, and not automatically. What should happen is a frank conversation.
For some patients the plan changes: a different implant position, avoiding a graft where a graft would be less predictable, or a staged approach with longer healing. For others the recommendation may be a bridge or another option that does not depend on bone integration. And in some cases the assessment is that implants remain a reasonable choice with realistic expectations set in advance.
What you should expect is that the risk is stated plainly, in writing where relevant, before you commit. A practice that does not mention smoking at all is not doing you a favour.
What else improves the outlook?
Smoking rarely sits alone. The factors that improve implant healing generally are worth attention together:
- Gum health before surgery. Active gum disease should be treated first.
- Blood sugar control if you have diabetes, as covered in our article on diabetes and implants.
- Cleaning around the implant afterwards. Peri-implantitis risk is higher in smokers, so the maintenance routine matters more, not less.
- Regular reviews, so changes around the implant are picked up early rather than late.
Being realistic about outcomes
Implant treatment in a smoker can work well. It can also fail in ways it would have been less likely to fail otherwise. Both statements are true, and any practice that gives you only one of them is not being straight with you.
Results differ between individuals. The purpose of assessment is to establish where you actually sit — bone volume, gum condition, medical history, smoking pattern — and then set out the options with their realistic prospects.
Arranging an assessment
Planning at Shine Dental Newington includes a CBCT scan taken on site and a written, itemised quote with item numbers before anything is booked. HICAPS on-the-spot claiming is available, and the practice is a CBHS and NIB preferred provider. Consultations run in English or Korean.
Call (02) 9748 4822, mobile 0430 442 018, or send an enquiry.