Smoking, vaping and All-on-6: what happens over the years

Why we are writing about the long term

Most advice about smoking and implants focuses on the weeks around surgery: stop beforehand, don't smoke while you heal. That matters, and our sister guide allon6turkey.co.uk covers how to plan stopping around a treatment trip. But the bigger story is what smoking does to implants over five, ten and fifteen years. That is what decides whether your All-on-6 lasts.

What the research shows

The clearest overview is a 2021 systematic review and meta-analysis from Malmö University. It pooled 292 publications covering more than 35,000 implants in smokers and more than 114,000 in non-smokers. The findings were consistent:

• More failures. Implants in smokers had an odds ratio of failure of about 2.4 compared with non-smokers. The authors described it as a 140% higher risk.
• Both jaws affected. The difference was significant in the upper jaw and in the lower jaw.
• More bone loss. The bone level around implants in smokers dropped on average about 0.6 mm more than in non-smokers.
• The gap did not close with time. Longer follow-up did not make the difference go away.

Remember that these are relative figures. Most implants in smokers still work. But with six implants carrying one bridge, every implant counts, and a higher failure rate across six implants adds up.

Why smoking harms implants

Smoking narrows small blood vessels, reduces oxygen reaching the healing tissue and dampens the body's normal response to bacteria. In the gums this means inflammation can be hidden: smokers' gums often bleed less, so problems are noticed later. The European Federation of Periodontology notes that even with good oral hygiene, smokers experience greater bone loss and deeper gum pockets, and that treatments such as implants and grafts are less successful in smokers because healing is generally poorer.

Heat and chemicals in smoke also affect the tissues directly. And many people needing All-on-6 lost their teeth to gum disease that smoking helped drive, so the same process can carry on around the implants. If that sounds familiar, read All-on-6 after gum disease.

Peri-implantitis: the slow risk

Peri-implantitis is inflammation that destroys the bone around an implant, much as gum disease destroys bone around teeth. It develops quietly over years. A 2025 systematic review by the Academy of Osseointegration and the American Academy of Periodontology, summarised by the British Society of Periodontology, found that the main risk factors were a history of gum disease, diabetes and smoking. Smoking was also among the strongest indicators of peri-implant mucositis, the earlier, reversible stage.

The practical message from that review was that smokers need closer recalls and more support with maintenance. Read peri-implantitis explained for the warning signs.

What about vaping?

Vaping avoids the tar and carbon monoxide of burning tobacco, and for many people it is a stepping stone to stopping smoking. Whether it is kind to implants is less clear. Most e-liquids contain nicotine, which narrows blood vessels, and many people find vaping dries the mouth. Research specifically on vaping and dental implants is still limited, and we have not found good long-term studies on it.

A sensible approach:

• If you smoke, switching to vaping is likely better than continuing to smoke, especially if it helps you stop altogether.
• Avoid vaping as well as smoking in the healing period if you can.
• Tell your dentist if you vape, how often and whether the liquid contains nicotine.
• If your mouth feels dry, read dry mouth and All-on-6.

Other nicotine products, such as pouches or chewing tobacco held against the gum, bring nicotine directly to the tissues around implants. Tell your dentist about these too.

What stopping does

The good news is that the body recovers. The European Federation of Periodontology says that in ex-smokers the gums can improve within a few years with good professional care, and that just one year after quitting, former smokers respond better to gum treatment than people who still smoke. It is reasonable to expect the tissues around implants to benefit in a similar way.

Getting help to stop

Stopping smoking is hard, and willpower alone works for few people. In the UK the NHS offers free help: local stop smoking services, nicotine replacement, prescription medicines and the NHS Quit Smoking app, all listed on the NHS Better Health website. Having a date for implant surgery can be a useful motivator.

• Set a quit date well before your surgery date.
• Tell your GP or pharmacist you are preparing for surgery.
• Plan for the hard moments: after meals, with coffee or alcohol, and in social situations.
• If you slip, tell your dentist honestly. It changes how they plan follow-up, not whether they help you.

If you are not ready to stop

Be honest with your dentist. They need to know to plan safely and to give you a realistic picture. Some will suggest a staged approach or fewer implants. For heavy smokers who cannot stop, a removable option such as an implant-retained denture, which is easier to clean around, may be wiser. The options are compared on All-on-6 and the alternatives.

Looking after implants as a smoker or ex-smoker

• Clean under the bridge every day; see cleaning and care.
• Keep hygiene visits more frequent than average; see hygienist visits.
• Do not rely on bleeding as a warning sign; smokers' gums may not bleed. Look for swelling, a bad taste or gum shrinking back.
• Have X-rays when advised, so bone changes are caught early.
• Keep the lifespan in perspective: how long All-on-6 lasts depends on these habits more than on anything the clinic does.

Nicotine replacement and the healing weeks

Patches, gum, lozenges and sprays are among the most effective ways to stop smoking, and they avoid the smoke and tar of cigarettes. They still contain nicotine, though, so ask your dentist whether they are happy for you to use them through the healing period and which form they prefer. Nicotine gum, for example, is chewed, which you may not want to do on temporary teeth in the first weeks. A patch is often the simplest choice while the implants heal. Do not let this question stop you quitting; agree a plan with your dentist and your stop smoking adviser.

What your dentist will look for at check-ups

Because smoking can hide bleeding, dentists rely on other signs in smokers and recent ex-smokers: the depth of the gap between gum and implant, any loss of bone on X-rays, gum shrinking back and the amount of plaque under the bridge. Expect X-rays at intervals your dentist sets and be prepared for the bridge to be removed occasionally for a thorough check. These visits are your best protection.

If you have stopped smoking before your treatment, well done. Tell your dentist how long ago you stopped; it helps them judge your risk accurately.

Common questions

Will a dentist refuse All-on-6 if I smoke?

Some may, especially for heavy smokers. The British Society of Periodontology lists active heavy smoking among the situations where implants may not be appropriate. Most dentists will explain the higher risk and strongly encourage you to stop first.

How long before surgery should I stop smoking?

The longer the better, and ideally for good. Your dentist will give you a minimum; even stopping for the healing period helps, but the long-term risk to the gum and bone around implants continues for as long as you smoke.

Is vaping safe with implants?

We do not know enough to say it is safe. Vaping avoids the tar and smoke of cigarettes, but research on vaping and implants is limited. If you use vaping to stop smoking, discuss it with your dentist and aim to stop vaping too in the healing period.

Does cutting down help?

It is better than not changing, but stopping completely gives the greatest benefit to the gum and bone around implants.

Where can I get help to stop smoking in the UK?

The NHS offers free support through local stop smoking services and the NHS Quit Smoking app, available from the NHS Better Health website.

Sources

1. Mustapha, Salame & Chrcanovic (2021), Medicina — Smoking and dental implants: systematic review and meta-analysis
2. British Society of Periodontology — Patient FAQs: dental implants (who may not be suitable)
3. British Society of Periodontology — Research Corner: risk factors for peri-implant diseases (AO/AAP systematic review)
4. European Federation of Periodontology — What is periodontitis? (smoking and treatment success)
5. NHS Better Health — Quit smoking

Checked October 2026. Where we give our own view as a clinic, we say so.