If you smoke and you’re considering dental implants, you’ve probably already heard somewhere that smoking is “bad for implants.” That’s true, but it’s not the whole story. Here’s the honest version — what the evidence actually says, what I see in practice, and what I’ll ask of you if you decide to go ahead at Biltoft.

Why smoking is a real problem for implants

An implant isn’t just a screw in a jaw. It only works because bone grows onto the titanium surface and locks it in place — a process called osseointegration. That process needs blood supply, oxygen, and time.

Smoking works against all three.

Nicotine constricts blood vessels and reduces blood flow to the gums and jawbone. Carbon monoxide from tobacco smoke reduces how much oxygen the blood can carry. On top of that, smoking suppresses the immune response that fights off infection during healing.

So when we place an implant in a smoker, we’re asking a wound with compromised blood supply to do a hard healing job. It’s not impossible — most of the time it still works — but the margin for error shrinks.

What the research actually shows

Multiple systematic reviews and meta-analyses have looked at smoking and implant failure. The consistent finding is that smokers lose implants at meaningfully higher rates than non-smokers, and that the risk tends to rise with how much you smoke. Chen and colleagues’ widely-cited 2013 meta-analysis identified smoking as an independent risk factor for implant failure, and more recent reviews have pointed in the same direction.

I’m not going to quote you a single failure percentage, because the numbers bounce around depending on the study design, patient population, and implant system. What I can tell you honestly is this: every decent review I’ve read puts smokers at higher risk, and nobody serious in the field argues otherwise.

The other big issue is longer-term. Smokers are more prone to peri-implantitis — essentially gum disease around an implant. Bone loss from peri-implantitis can cost you an implant years after it was placed and originally healed fine. That’s the slow-burn risk that often gets glossed over.

What I ask of patients who smoke

I’m not going to refuse to place an implant because you smoke. That’s not my call to make for you, and turning people away doesn’t help them — it just sends them somewhere else where the conversation might not happen at all.

What I do ask is this:

  • A frank conversation at the consult. How much you smoke, how long you’ve smoked, whether you’ve tried to quit before. Not to judge — to plan.
  • A genuine attempt to stop or cut down around the surgery window. The guidance I work from is at least two weeks before surgery and six weeks after. That’s the period where osseointegration is happening. Longer is better. Even partial reduction helps.
  • Commitment to the aftercare. Regular cleans, good home hygiene, and showing up for reviews. Smokers need tighter maintenance, not looser.
  • Honesty about vaping. If you’ve switched to vaping, tell me. It probably still matters, even if the data is thinner.

If you’re not willing to do any of the above, I’ll still have the conversation — but I’ll be straight with you that the odds aren’t as good, and I’ll want that on the record before we proceed.

If you’re in Murwillumbah or the Tweed region and this sounds like the kind of conversation you want to have, book a consult with me at Biltoft and we’ll talk it through properly.

Harm reduction is real — quitting is better

There’s a school of thought that says unless you quit entirely, none of it matters. I don’t buy that, and the evidence doesn’t support it either.

Smoking risk is dose-dependent. Someone who goes from 20 a day to 5 a day has genuinely reduced their risk, even if they haven’t stopped. Someone who quits for eight weeks around surgery and then goes back to a few a day has still given their implant a meaningfully better chance of integrating.

So if you can’t quit for good, cut down. If you can’t cut down long-term, cut down for the surgery window. Every bit helps.

That said — quitting is still the gold standard. Your implant will heal better, your gums will be healthier long-term, and the rest of your body will thank you. If you’re thinking about implants anyway, this might be the nudge that makes quitting worth the effort.

What about vaping?

This is the question I get asked a lot now, and I want to be honest about what I don’t know.

Vaping is newer than traditional smoking, so we have less long-term data on implant outcomes specifically. What we do know:

  • Nicotine is nicotine. It still constricts blood vessels and slows healing, whether it’s from a cigarette or a vape.
  • Some vape liquids irritate gum tissue and can contribute to dry mouth, which is bad for oral health generally.
  • A handful of smaller studies have started to suggest vapers sit somewhere between smokers and non-smokers for implant risk — but the data is early and I wouldn’t hang my hat on it.

My working position: I treat vaping as a risk factor. Probably less severe than combustible tobacco, but not neutral. If you vape, the same rules apply — cut down or stop around the surgery window if you can.

Getting help to quit

If you decide to quit — for the implant, for your overall health, or both — you don’t have to figure it out alone. Some free resources that actually work:

  • Quitline — 13 78 48 — free, confidential phone counselling. Trained advisors who can help you build a quit plan tailored to you.
  • Healthdirect’s quit smoking resources — Australian government health information on quitting methods, nicotine replacement, and what to expect.
  • Your GP. Prescription medications like varenicline, and subsidised nicotine replacement therapy, can dramatically increase your chances of quitting. Worth a conversation.

If you’d like, I can also have a chat about it at your implant consult — no lecture, no judgement, just practical.

The bottom line

Smoking makes dental implants riskier, both in the short term (failure to integrate) and the long term (peri-implantitis and bone loss). It doesn’t rule out implants. It does mean the honest version of the conversation is longer, and the aftercare is more important.

At Biltoft, implants are priced at $5,000–$6,000 per tooth, placed under local anaesthetic. We don’t offer IV sedation in-house — if you need that level of sedation, I’ll refer you to an oral surgeon. What we do offer is a frank conversation about your situation and a plan that gives your implant the best shot at lasting.

If you want to read more, start with our dental implants guide, then have a look at are you a candidate for dental implants and why dental implants fail to round out the picture.

When you’re ready, book a consult or give us a call on (02) 6672 1980. We’ll sit down, look at your mouth, talk about smoking honestly, and work out whether implants make sense for you — or whether there’s a better path.

Frequently asked questions

Will you refuse to place an implant if I smoke? +

No. I won't turn you away for smoking, but I will have a frank conversation about risk. If you're willing to cut back — or better, quit — around the surgery window and commit to the aftercare, we can talk about going ahead. Individual results vary, and I'd rather you hear the honest version up front than find out the hard way.

How long before the implant surgery should I stop smoking? +

The evidence points to stopping at least two weeks before and six weeks after as the minimum useful window. That's when the bone is trying to fuse to the implant, and nicotine is actively working against you. Longer is better. Even a few days off helps blood flow to the gums.

Is vaping any safer for implants than smoking? +

There's less long-term data on vaping and implants, but nicotine is nicotine — it constricts blood vessels and slows healing however it's delivered. Some vape liquids also irritate gum tissue. My honest position: I treat vaping as a risk factor, just with less certainty about the size of the risk.

If I cut down but don't quit, does that help at all? +

Yes. The research suggests risk scales with how much you smoke. Going from a pack a day to five cigarettes still reduces your risk compared to not changing anything. Quitting is the gold standard, but harm reduction is real and worth doing.

What does smoking actually do to a dental implant? +

Two main things. Short-term, nicotine cuts blood flow to the gums and bone, which slows healing and disrupts osseointegration — the process where bone grows onto the implant surface. Long-term, smokers are more prone to peri-implantitis, a gum infection around the implant that eats away at supporting bone and can cost you the implant years down the track.

Where can I get help to quit before surgery? +

Quitline (13 78 48) is free, confidential, and staffed by trained counsellors. Quit.org.au has a Quit plan tool and resources. Your GP can also prescribe nicotine replacement or medications like varenicline. We're happy to chat about it at your consult — no judgement.