The Impact of Cigarette Smoking, Waterpipe Smoking, and E-Cigarette Vaping on Peri-Implant Clinical Outcomes and Inflammatory Markers: a Systematic Review and Meta-Analysis

Cigarette smoking exerts the greatest detrimental effect on peri-implant outcomes, followed by waterpipe and e-cigarette use. All modalities promote bone loss, plaque accumulation, and inflammation despite reduced bleeding, likely due to nicotine-induced vasoconstriction. Evidence on waterpipe and vaping remains limited, emphasizing the need for standardized long-term studies.