Influence of Smoking on Long‐Term Clinical Results of Intrabony Defects Treated With Regenerative Therapy

Abstract

This retrospective study compares the short-term (1 year) and long-term (2 to 5 year) clinical results of regenerative therapy in clinical private practice using a bone allograft for the treatment of intrabony defects in smokers and non-smokers. A total of 110 intrabony lesions were treated with demineralized freeze-dried bone allograft (DFDBA) following thorough defect debridement and root preparation in 53 patients (15 cigarette smokers and 38 non-smokers). Assessments of clinical attachment level (CAL) and probing depth (PD) were recorded at pre-treatment, 1 year post-treatment, and 2 to 5 years post-treatment. At 1 year post-treatment, significant gains in mean CAL were maintained for both smokers (2.7 mm) and non-smokers (3.4 mm). Similarly, significant reductions in mean PD were observed for smokers (3.0 mm) and non-smokers (3.8 mm) at the 1-year follow-up. However, when comparing relative improvements in clinical measures, smokers were found to exhibit significantly poorer treatment results (i.e., sites exhibited less CAL gain) at 1 year and 2 to 5 years follow-up. Relative to pre-treatment scores, differences in improvements observed for CAL at the 1-year evaluation (29.2% for smokers and 42.5% for non-smokers) were sustained in the subgroup of patients at 2 to 5 years follow-up (31.3% for smokers and 41.8% for non-smokers). Similar but non-significant trends were observed for relative reductions in probing depth for smokers and non-smokers at 1 year (41.9% for smokers and 49.3% for non-smokers) and 2 to 5 years follow-up (43.9% for smokers and 48.3% for non-smokers) for the subgroup of patients followed beyond 1 year. These results suggest that smoking adversely affects treatment outcome, as measured by gains in clinical attachment levels of intrabony defects treated by regenerative therapy using DFDBA.

Smoking and Periodontal Disease

“…In the description of the appearance of smokers' periodontal condition, and in studies looking cross-sectionally at smokers, a commonlv noted feature is the level of recession, which is often noted as worse in smokers than in non-smokers (Martinez-Canutt et a., 1995;Gunsolley et al, 1998 (Cortellini et al, 1996. Trombelli andScabia, 1997;, and other investigators, when using regenerative procedures with allografts, have also found smoking to be detrimental to healing (Luepke et al, 1997;Rosen et al, 1996) Haas et al (I 996) Fibroblasts are an important cell in the periodontal heal-REFERENCE ing response, and Raulin et al (1988) has reported an impaired function of fibroblasts in smokers. Fibroblasts Ah MK, Johr have been shown to bind and internalize nicotine (Hanes (1994).…”

Tobacco smoking and chronic destructive periodontal disease

“…A few long-term studies also show an inferior outcome in smokers. [61][62][63][64][65] All of these, except one, 63 concern surgical therapy. The one study that evaluates the influence of smoking on both surgical and non-surgical treatments suggests that the negative effect of smoking holds true irrespective of treatment modality.…”

Periodontitis and Smoking: An Evidence-Based Appraisal

“…Several intervention studies included in the present appraisal have applied regenerative techniques such as GTR membranes and/or allografts. [120][121][122]124,[126][127][128][129] In spite of their diversity regarding surgical modality, endpoint selection and follow-up length, the surgical therapy intervention studies consistently point to an inferior outcome in smokers compared with nonsmokers. As with nonsurgical studies, most of the surgical studies use average changes in PPD, CAL, and/or PBL as the endpoint(s) of choice.…”