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Int J Oral Maxillofac Surg. 2014 Mar;43(3):323-34. doi: 10.1016/j.ijom.2013.11.012. Epub 2013 Dec 25.

Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis.

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Department of Dentistry, University "Tor Vergata", Rome, Italy.
Oral Biology Program, Implantodontics, Sagrado Coração University, Bauru, Sao Paulo, Brazil.
Department of Oral Surgery, University of Valencia, Valencia, Spain.
Independent Researcher, Rome, Italy.
Department of Prosthodontics, Bauru Dental School, Sao Paulo University, Bauru, Sao Paulo, Brazil.
Independent Researcher, Rome, Italy. Electronic address:


The aim of this study was to determine the influence of patient-related systemic risk factors (systemic disease, genetic traits, chronic drug or alcohol consumption, and smoking status) on peri-implant bone loss at least 1 year after implant installation and prosthetic loading. An electronic search was performed of MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials up to January 2012. One thousand seven hundred and sixty-three studies were identified. After applying a three-stage screening process, 17 articles were included in the qualitative analysis, but only 13 in the quantitative analysis, since smoking was a common exposure. The meta-analysis of these 13 studies (478 smokers and 1207 non-smokers) revealed a high level of heterogeneity and that smoking increases the annual rate of bone loss by 0.164 mm/year. Exposure to smoking had a harmful effect on peri-implant bone loss. However, the level of evidence for oral implant therapy in patients with systemic conditions is very low. Future studies should be improved in order to provide more robust data for clinical application.


bone loss; dental implants; meta-analysis; risk factors; smoking; systemic diseases

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