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Does Smoking Impair Bone Regeneration in the Dental Alveolar Socket?

Journal article
Authors Furqan A. Shah
Shariel Sayardoust
Omar Omar
Peter Thomsen
Anders Palmquist
Published in Calcified Tissue International
Volume 105
Issue 6
Pages 619-629
ISSN 0171-967X
Publication year 2019
Published at Institute of Clinical Sciences, Department of Biomaterials
Pages 619-629
Language en
Keywords Bone, Smoking habit, Alveolar process, Extracellular matrix, Bone, regeneration, Raman spectroscopy, implant crevicular fluid, collagen cross-links, titanium implants, gene-expression, follow-up, mechanical-properties, carbonated apatites, heavy smoking, tobacco use, i collagen
Subject categories Clinical Medicine


Smoking is a major risk factor for dental implant failure. In addition to higher marginal bone loss around implants, the cellular and molecular responses to injury and implant physicochemical properties are also differentially affected in smokers. The purpose of this work is to determine if smoking impairs bone microstructure and extracellular matrix composition within the dental alveolar socket after tooth extraction. Alveolar bone biopsies obtained from Smokers (> 10 cigarettes per day for at least 10 years) and Ctrl (never-smokers), 7-146 months after tooth extraction, were investigated using X-ray micro-computed tomography, backscattered electron scanning electron microscopy, and Raman spectroscopy. Both Smokers and Ctrl exhibited high inter- and intra-individual heterogeneity in bone microstructure, which varied between dense cortical and porous trabecular architecture. Regions of disorganised/woven bone were more prevalent during early healing. Remodelled lamellar bone was predominant at longer healing periods. Bone mineral density, bone surface-to-volume ratio, mineral crystallinity, the carbonate-to-phosphate ratio, the mineral-to-matrix ratio, the collagen crosslink ratio, and the amounts of amino acids phenylalanine and proline/hydroxyproline were also comparable between Smokers and Ctrl. Bone microstructure and composition within the healing dental alveolar socket are not significantly affected by moderate-to-heavy smoking.

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