Association between conventional cigarette smoking behavior and peri-implantitis: a survey-based cross-sectional study

BACKGROUND: Although smoking is a well-recognized risk indicator for peri-implantitis (PI), the association between the intensity of current smoking and PI remains insufficiently characterized. This study investigated the association between smoking exposure, categorized according to daily cigarette consumption, and PI in a survey-based cross-sectional study. METHODS: A total of 1,021 patients with at least one functional dental implant were included. Peri-implant conditions were classified at the patient level according to the implant site showing the poorest peri-implant condition in each participant, based on standardized clinical and radiographic criteria. Smoking exposure was assessed using a self-administered questionnaire and categorized as non-smoker, former smoker, or current smoker, with current smokers further stratified as light smokers (1-9 cigarettes/day), moderate smokers (10-19 cigarettes/day), or heavy smokers (≥ 20 cigarettes/day). Logistic regression analyses were performed to estimate crude and adjusted odds ratios for PI after sequential adjustment for age, sex, periodontitis stage, diabetes mellitus, and hypertension. RESULTS: PI was identified in 150 participants (14.7%). Moderate smokers exhibited significantly higher odds of PI (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.13-3.59), and heavy smokers showed the highest odds (AOR = 3.57; 95% CI, 2.00-6.38). In contrast, the estimates for former smokers and light smokers were not statistically significant and should be interpreted cautiously because of the small number of PI events and wide CIs. CONCLUSION: Higher daily cigarette consumption was associated with higher odds of PI, with significant associations observed in individuals smoking 10 or more cigarettes per day. These findings support the clinical relevance of assessing daily cigarette consumption during peri-implant risk evaluation. However, longitudinal studies are needed to confirm temporality and to further refine smoking-related risk assessment in peri-implant care.