Effect Of Smoking On Non-Surgical Therapy Of Peri-Implant Diseases

Purpose: Peri-implant diseases are inflammatory occurring in peri-implant tissues,including peri-implant mucositis and peri-implantitis.A variety of non-surgical methods have been used in the treatment of peri-implant diseases,and certain curative effects have been achieved.However,the effect of smoking on the nonsurgical treatment of peri-implant disease remains controversial.The purpose of this study was to evaluate the effect of smoking on the clinical outcome of non-surgical treatment of peri-implant diseases through systematic evaluation,in order to provide guidance for the treatment of patients with smoking and peri-implant diseases.Methods: Chinese and foreign databases such as Pubmed and CNKI were searched up to August 2022.The studies about the effect of smoking on the treatment of peri-implant diseases were included.The studies was screened according to the inclusion criteria.Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included studies.The studies with medium or above quality were selected for data extraction.Meta-analysis was performed in Rev Man 5.4.1 software.Weighted mean difference(WMD)and 95% effect interval(CI)were used as effect indexes.To investigate the difference of bleeding on probing(BOP),probing depth(PD)and crestal bone loss(CBL)before and after non-surgical treatment in smoking and non-smoking patients with peri-implant diseases.Then,subgroup analysis was performed based on different treatment methods,clinical parameters before treatment,follow-up time and disease types to evaluate whether these variables would affect the results of metaanalysis.Results: Finally,9 studies were included,all of which were prospective cohort studies with medium or above quality.Results of meta-analysis showed that after nonsurgical treatment,patients with peri-implant disease(NS)had more significant improvement in BOP(-23.99 [CI:-27.28,-20.69])and PD(-0.55 [CI:-0.86,-0.24])than patients with peri-implant disease combined with smoking(S),P<0.05.The improvement of CBL between the two groups(-0.13[CI:-0.31,0.06])was not statistically significant,P>0.05.Subgroup analysis showed:(1)In the subgroup analysis by treatment means,the improvement of BOP in the NS group was more significant than that in the S group,whether mechanical debridement combined with antibacterial therapy(-26.24 [CI:-31.25,-21.23])or mechanical debridement(-19.29[CI:-22.88,-15.70]).The improvement of PD(-0.55 [CI:-0.93,-0.18])and CBL(-0.25[CI:-0.32,-0.17])in NS group was more significant than that in S group after mechanical debridement combined with antibacterial therapy,P<0.05.There was no significant difference in the improvement of PD(-0.55 [CI:-1.14,0.04])and CBL(-0.03 [CI:-0.11,0.05])after mechanical debridement,P>0.05.(2)In the subgroup analysis by mean clinical parameter difference at baseline,the improvement of BOP and PD in NS group after non-surgical treatment was more significant than that in S group,regardless of the difference between the two groups,P<0.05.(3)In the subgroup analysis by follow-up time,the improvement of BOP and PD in the NS group after nonsurgical treatment was more significant than that in the S group,P<0.05.(4)In subgroup analyses with different disease types,analysis of BOP showed that either periimplant mucositis(-25.61 [CI:-33.19,-18.02])or peri-implantitis(-24.05 [CI:-29.93,-18.17]),after nonsurgical treatment,the improvement of BOP in the NS group was more significant than that in the S group,P<0.05.Analysis of PD showed that in patients with peri-implantitis(-1.64 [CI:-2.34,-0.95]),the improvement of PD in the NS group was more obvious than that in the S group after non-surgical treatment,P<0.05;In patients with peri-implant mucositis,PD improvement between the two groups(-0.14 [CI:-0.85,0.57])was not statistically significant,P>0.05.Conclusions: After nonsurgical treatment of peri-implant disease,smoking patients had worse outcomes than non-smoking patients.This difference did not disappear with longer follow-up time,difference in clinical parameters at baseline,or type of peri-implant disease.Dentists should inform patients the harmful effects of smoking on the treatment of peri-implant diseases.Smoking has a more significant effect on the clinical effect of mechanical debridement combined with adjuvant antibacterial therapy.It can be inferred that smoking will significantly affect the effect of antibacterial photodynamic.More efficient antibacterial means should be tried to improve the treatment effect of peri-implant diseases.