Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden.
Clin Implant Dent Relat Res. 2017 Oct;19(5):901-915. doi: 10.1111/cid.12514. Epub 2017 Jul 26.
The mechanisms behind the impact of smoking on osseointegration are not fully understood.
To investigate the initial clinical and molecular course of osseointegration of different implants in smokers and non-smokers in a randomized controlled trial (RCT).
Smoking (n = 16) and non-smoking (n = 16) patients received 3 implant types: machined, oxidized, and laser-modified surfaces. Baseline bone biopsies were retrieved from the implant sites. After 60 and 90 days, the pain score, implant stability quotient (ISQ), and peri-implant crevicular fluid (PICF) gene expression were analyzed. Furthermore, radiological and clinical assessments were made at 90 days.
At 90 days, no pain was reported, irrespective of smoking habit. A higher ISQ was found in smokers compared with non-smokers. Marginal bone loss (MBL) was greater in smokers than in non-smokers. The comparison of implant surfaces revealed greater MBL exclusively at the machined implants in smokers. At 90 days in smokers, the PICF around machined implants revealed a higher expression of the proinflammatory cytokine, interleukin-6 (IL-6), and a lower expression of the osteogenic gene, osteocalcin (OC), compared with the PICF around modified implants. Furthermore, OC expression was lower at machined implants in smokers compared with machined implants in non-smokers. After adjustment for age and implant location (maxilla/mandible), multivariate regression revealed the following predictors of MBL: smoking, bleeding on probing at 90 days, hypoxia-inducible factor 1 alpha (HIF-1α) expression at baseline and IL-6 expression in PICF at 90 days.
During the early phase of osseointegration, non-smokers and smokers present a similar, high implant survival. In contrast, smokers present a greater MBL, particularly at machined implants. HIF-1α baseline expression in the recipient bone and IL-6 expression in PICF cells are important molecular determinants for MBL after 90 days. It is concluded that smoking has an early effect on osseointegration, which is dependent on the implant surface properties and the local host response.
吸烟对骨整合影响的机制尚未完全阐明。
通过随机对照试验（RCT）研究吸烟和不吸烟者中不同种植体骨整合的初始临床和分子过程。
吸烟（n=16）和不吸烟（n=16）患者接受了 3 种种植体类型：机械加工、氧化和激光改性表面。从种植体部位取出基线骨活检。60 和 90 天后，分析疼痛评分、种植体稳定性指数（ISQ）和种植体周龈沟液（PICF）的基因表达。此外，在 90 天时还进行了影像学和临床评估。
在 90 天时，无论吸烟习惯如何，均未报告疼痛。吸烟者的 ISQ 高于不吸烟者。吸烟者的边缘骨丢失（MBL）大于不吸烟者。种植体表面的比较显示，仅在吸烟者的机械加工种植体中，MBL 更大。在吸烟者中，90 天时，与改性种植体周围的 PICF 相比，机械加工种植体周围的 PICF 显示促炎细胞因子白细胞介素 6（IL-6）表达增加，成骨基因骨钙素（OC）表达降低。此外，与不吸烟者的机械加工种植体相比，吸烟者的机械加工种植体的 OC 表达较低。在调整年龄和种植体位置（上颌/下颌）后，多元回归显示 MBL 的以下预测因子：吸烟、90 天时探诊出血、基线时缺氧诱导因子 1 阿尔法（HIF-1α）表达和 90 天时 PICF 中的 IL-6 表达。
在骨整合的早期阶段，非吸烟者和吸烟者的种植体存活率相似，均较高。相比之下，吸烟者的 MBL 更大，尤其是在机械加工种植体上。受体骨中的 HIF-1α 基础表达和 PICF 细胞中的 IL-6 表达是 90 天后 MBL 的重要分子决定因素。研究结论为吸烟对骨整合有早期影响，这种影响取决于种植体表面特性和局部宿主反应。
