Introduction: Cigarette smoking has long been associated with a variety of oral pathological conditions including periodontal disease, bone and tooth loss, peri-implantitis and implant failure. Purpose: The purpose of this study was to compare the marginal implant bone loss (MBL), survival, and success of dental implants among smoking and non-smoking individuals. Participants and Methods: A cohort of 161 consecutive files of patients (ages 23-89, mean age 57 years) treated with a total of 646 implants between the years 1995 and 1998, were examined. Patients were divided into 3 groups: non-smokers (Non-S), moderate-smokers (MS) and heavy-smokers (HS), depicting the tobacco exposure as expressed in cigarettes per day and the amount of cigarettes smoked in pack-years (PY). The mean follow up time was 3.8 years (range 1-7 years). Post operative panoramic radiographs were taken before implant exposure then yearly. The radiographs were analyzed for MBL changes. The influence of smoking on MBL, success and survival was analyzed. Results: Overall, S had higher MBL compare to Non-S, 0.153±0.092 and 0.047±0.048 respectively, p<0.001. When scrutinizing each jaw separately, smoking had a greater effect on MBL in the maxilla than in the mandible, 0.158±0.171 and 0.146±0.158 respectively, p<0.001. Furthermore, in the maxilla the HS had the highest MBL (0.1897±0.18247), followed by MS (0.1233±0.1555) and Non-S (0.046±0.0703), p<0.001. In the mandible, there was no distinction between HS and MS, and both had higher MBL than Non-S (p<0.001). Of the 646 implants, only 3 failed after loading. The 7 years cumulative survival rate was 99.53%. The overall success rate was 93.2%. Non-S had a higher success rate (97.1%) than S (87.8%), p<0.001. Conclusion: This study established a relationship between MBL and smoking habits. A higher incidence of MBL was found in smokers, this was more accentuated in the maxilla.

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