The effect of electronic cigarette use on peri-implant conditions in men: a systematic review and meta-analysis

Published:August 31, 2022DOI:


      To systematically review the effect of electronic cigarette (e-cigarette) use on clinical, radiographic, and immunologic peri-implant parameters in males.

      Study Design

      A comprehensive search of indexed databases was conducted to identify studies reporting data on both e-cigarette users and nonsmokers with implant-supported prosthesis with ≥1-year in function, up to May 2022. Marginal bone loss (MBL), probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were recorded. Peri-implant sulcular fluid volume (PISF), tumor necrosis factor alpha (TNF-α) and interleukin 1β (IL-β) levels were also assessed. A meta-analysis was performed using random-effect models to determine the effect of e-cigarette use in primary and secondary outcomes.


      Four cross-sectional studies were included with a total of 327 participants (165 e-cigarette users and 162 nonsmokers). All studies showed greater MBL, PI, PD, and lower BOP in e-cigarette users compared with never smokers. The meta-analysis indicated significant heterogeneity for all outcomes except MBL for distal implant surfaces, with the mean difference between e-cigarette users and nonsmokers of 0.89 mm (95% CI: 0.67-1.11, P < .01). The PISF volume, TNF-α, and IL-1β levels were increased in e-cigarette users (P < .01) with no heterogeneity present between studies.


      E-cigarette use shows a negative effect on clinical, radiographic, and immunologic parameters of dental implants.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Warren GW
        • Alberg AJ
        • Kraft AS
        • Cummings KM.
        The 2014 Surgeon General's report: “The health consequences of smoking–50 years of progress”: a paradigm shift in cancer care.
        Cancer. 2014; 120: 1914-1916
      1. Center for Disease Control and Prevention. Office on Smoking and Health At A Glance. Available at: Accessed March 25, 2020.

        • Regan AK
        • Promoff G
        • Dube SR
        • Arrazola R.
        Electronic nicotine delivery systems: adult use and awareness of the 'e-cigarette' in the USA.
        Tob Control. 2013; 22: 19-23
        • Farsalinos KE
        • Romagna G
        • Tsiapras D
        • Kyrzopoulos S
        • Voudris V.
        Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers.
        Int J Environ Res Public Health. 2014; 11: 4356-4373
        • Caraballo RS
        • Jamal A
        • Nguyen KH
        • Kuiper NM
        • Arrazola RA.
        Electronic nicotine delivery system use among U.S. adults, 2014.
        Am J Prev Med. 2016; 50: 226-229
        • Zhu SH
        • Sun JY
        • Bonnevie E
        • et al.
        Four hundred and sixty brands of e-cigarettes and counting: Implications for product regulation.
        Tob Control. 2014; 23: iii3-iii9
      2. E-Cigarette use among youth and young adults: a report of the Surgeon General. 2016.

        • Lerner CA
        • Sundar IK
        • Watson RM
        • et al.
        Environmental health hazards of e-cigarettes and their components: oxidants and copper in e-cigarette aerosols.
        Environ Pollut. 2015; 198: 100-107
        • U.S. Food &Drug Administration
        Tobacco Product Problem Reports. 2019;
        • Wadia R
        • Booth V
        • Yap HF
        • Moyes DL.
        A pilot study of the gingival response when smokers switch from smoking to vaping.
        Br Dent J. 2016; 221: 722-726
        • Javed F
        • Kellesarian SV
        • Sundar IK
        • Romanos GE
        • Rahman I.
        Recent updates on electronic cigarette aerosol and inhaled nicotine effects on periodontal and pulmonary tissues.
        Oral Dis. 2017; 23: 1052-1057
        • Chrcanovic BR
        • Albrektsson T
        • Wennerberg A.
        Smoking and dental implants: a systematic review and meta-analysis.
        J Dent. 2015; 43: 487-498
        • Javed F
        • Rahman I
        • Romanos GE.
        Tobacco-product usage as a risk factor for dental implants.
        Periodontol 2000. 2019; 81: 48-56
        • Negri BM
        • Pimentel SP
        • Casati MZ
        • Cirano FR
        • Casarin RC
        • Ribeiro FV.
        Impact of a chronic smoking habit on the osteo-immunoinflammatory mediators in the peri-implant fluid of clinically healthy dental implants.
        Arch Oral Biol. 2016; 70: 55-61
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
      3. The Joanna Briggs Institute. Available at:

      4. SAS Institute Inc. C, NC, USA. SAS Analytics Software & Solutions. Available at:

        • Alahmari F
        • Javed FA-O
        • Ahmed ZU
        • Romanos GE
        • Al-Kheraif AA
        Soft tissue status and crestal bone loss around conventionally-loaded dental implants placed in cigarette- and waterpipe (narghile) smokers: 8-years' follow-up results.
        Clin Implant Dent Relat Res. 2019; 21: 873-878
        • Alqahtani FA-O
        • Alqhtani N
        • Divakar DD
        • Shetty SB
        • Shetty B
        • Alkhtani F.
        Self-rated peri-implant oral symptoms and clinicoradiographic characteristics in Narghile-smokers, cigarette-smokers, and nonsmokers with peri-implantitis.
        Clin Implant Dent Relat Res. 2019; 21: 1235-1240
        • Al Deeb M
        • Alresayes S
        • Mokeem SA
        • et al.
        Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: a randomized controlled clinical trial.
        Photodiagnosis Photodyn Ther. 2020; 31101800
        • Akram ZA-O
        • Vohra F
        • Bukhari IA
        • Sheikh SA
        • Javed F.
        Clinical and radiographic peri-implant parameters and proinflammatory cytokine levels among cigarette smokers, smokeless tobacco users, and nontobacco users.
        Clin Implant Dent Relat Res. 2018; 20: 76-81
        • Haas R
        • Haimböck W
        • Mailath G
        • Watzek G.
        The relationship of smoking on peri-implant tissue: a retrospective study.
        J Prosthet Dent. 1996; 76: 592-596
        • Galindo-Moreno P
        • Fauri M
        • Avila-Ortiz G
        • Fernández-Barbero JE
        • Cabrera-León A
        • Sánchez-Fernández E.
        Influence of alcohol and tobacco habits on peri-implant marginal bone loss: a prospective study.
        Clin Oral Implants Res. 2005; 16: 579-586
        • Alqahtani F
        • Alqahtani M
        • Albaqawi AH
        • Al-Kheraif AA
        • Javed F.
        Comparison of cotinine levels in the peri-implant sulcular fluid among cigarette and waterpipe smokers, electronic-cigarette users, and nonsmokers.
        Clin Implant Dent Relat Res. 2019; 21: 702-707
        • AlQahtani MA
        • Alayad AS
        • Alshihri A
        • Correa FOB
        • Akram Z.
        Clinical peri-implant parameters and inflammatory cytokine profile among smokers of cigarette, e-cigarette, and waterpipe.
        Clin Implant Dent Relat Res. 2018; 20: 1016-1021
        • Al-Aali KA
        • Alrabiah M
        • ArRejaie AS
        • Abduljabbar T
        • Vohra F
        • Akram Z.
        Peri-implant parameters, tumor necrosis factor-alpha, and interleukin-1 beta levels in vaping individuals.
        Clin Implant Dent Relat Res. 2018; 20: 410-415
        • ArRejaie AS
        • Al-Aali KA
        • Alrabiah M
        • et al.
        Proinflammatory cytokine levels and peri-implant parameters among cigarette smokers, individuals vaping electronic cigarettes, and non-smokers.
        J Periodontol. 2019; 90: 367-374
        • Sinha DK
        • Vishal Kumar A
        • Khan M
        • Kumari R
        • Kesari M
        Evaluation of tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-1beta levels among subjects vaping e-cigarettes and nonsmokers.
        J Family Med Prim Care. 2020; 9: 1072-1075
        • Javed F
        • Abduljabbar T
        • Vohra F
        • Malmstrom H
        • Rahman I
        • Romanos GE.
        Comparison of periodontal parameters and self-perceived oral symptoms among cigarette smokers, individuals vaping electronic cigarettes, and never-smokers.
        J Periodontol. 2017; 88: 1059-1065
        • ALHarthi SS
        • BinShabaib M
        • Akram Z
        • Rahman I
        • Romanos GE
        • Javed F.
        Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study.
        Clin Oral Investig. 2019; 23: 2751-2758
        • BinShabaib M
        • ALHarthi SS
        • Akram Z
        • et al.
        Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers.
        Arch Oral Biol. 2019; 102: 212-217
        • Kumar PS
        • Clark P
        • Brinkman MC
        • Saxena D.
        Novel nicotine delivery systems.
        Adv Dent Res. 2019; 30: 11-15
        • Javed F
        • Al-Askar M
        • Samaranayake LP
        • Al-Hezaimi K
        Periodontal disease in habitual cigarette smokers and nonsmokers with and without prediabetes.
        Am J Med Sci. 2013; 345: 94-98
        • Wang Y
        • Wan C
        • Deng L
        • et al.
        The hypoxia-inducible factor alpha pathway couples angiogenesis to osteogenesis during skeletal development.
        J Clin Invest. 2007; 117: 1616-1626
        • Javed F
        • Al-Kheraif AA
        • Salazar-Lazo K
        • et al.
        Periodontal inflammatory conditions among smokers and never-smokers with and without type 2 diabetes mellitus.
        J Periodontol. 2015; 86: 839-846
        • Sopori M.
        Effects of cigarette smoke on the immune system.
        Nat Rev Immunol. 2002; 2: 372-377
        • Mehta H
        • Nazzal K
        • Sadikot RT.
        Cigarette smoking and innate immunity.
        Inflamm Res. 2008; 57: 497-503
        • Hartmann T
        • Marino F
        • Duffield R.
        Tobacco smoking and acute exercise on immune-inflammatory responses among relative short and longer smoking histories.
        Cytokine. 2019; 123154754
        • Cogo K
        • Calvi BM
        • Mariano FS
        • Franco GC
        • Goncalves RB
        • Groppo FC.
        The effects of nicotine and cotinine on Porphyromonas gingivalis colonisation of epithelial cells.
        Arch Oral Biol. 2009; 54: 1061-1067
        • Gorudko IV
        • Kostevich VA
        • Sokolov AV
        • et al.
        Functional activity of neutrophils in diabetes mellitus and coronary heart disease: role of myeloperoxidase in the development of oxidative stress.
        Bull Exp Biol Med. 2012; 154: 23-26
        • Sundar IK
        • Javed F
        • Romanos GE
        • Rahman I.
        E-cigarettes and flavorings induce inflammatory and pro-senescence responses in oral epithelial cells and periodontal fibroblasts.
        Oncotarget. 2016; 7: 77196-77204
        • Clapp PW
        • Pawlak EA
        • Lackey JT
        • et al.
        Flavored e-cigarette liquids and cinnamaldehyde impair respiratory innate immune cell function.
        Am J Physiol Lung Cell Mol Physiol. 2017; 313: L278-L292
        • Hermann JS
        • Schoolfield JD
        • Nummikoski PV
        • Buser D
        • Schenk RK
        • Cochran DL.
        Crestal bone changes around titanium implants: a methodologic study comparing linear radiographic with histometric measurements.
        Int J Oral Maxillofac Implants. 2001; 16: 475-485
        • Eke PI
        • Dye BA
        • Wei L
        • et al.
        Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012.
        J Periodontol. 2015; 86: 611-622
        • Albandar JM.
        Periodontal diseases in North America.
        Periodontol 2000. 2002; 29: 31-69