The Impact of Cigarette Smoking, Waterpipe Smoking, and E-Cigarette Vaping on Peri-Implant Clinical Outcomes and Inflammatory Markers: a Systematic Review and Meta-Analysis
Abstract
ABSTRACT Objectives The purpose of this systematic review and meta-analysis was to evaluate and compare the impact of cigarette smoking, waterpipe smoking, and electronic cigarette vaping on peri-implant clinical outcomes and inflammatory biomarkers in comparison with non-smokers. Material and Methods The systematic review was conducted following PRISMA guidelines. A comprehensive literature search was performed using the MEDLINE (PubMed) database. Studies published between October 2015 and October 2025 involving adults with dental implants were included. Random-effects models calculated mean differences (MD) for marginal bone loss and cytokines, and standardized mean differences (SMD) for plaque index and bleeding on probing (BOP). Results All smoking modalities were associated with significantly worse peri-implant outcomes than non-smokers. Plaque index increased for cigarette (+5.22 units), waterpipe (+6.31), and e-cigarette users (+1.61). Marginal bone loss was greater in cigarette (+2.16 mm), waterpipe (+1.9 mm), and e-cigarette users (+0.83 mm). Cigarette smokers showed the highest IL-1β (MD = 239.63 pg/mL), while e-cigarette users exhibited elevated IL-1β (+170 pg/mL) and TNF-α (+17.6 pg/mL). A paradoxical reduction in BOP was observed. Subgroup analyses confirmed a risk gradient of cigarette > waterpipe > e-cigarette > non-smoker. Conclusions Cigarette smoking exerts the greatest detrimental effect on peri-implant outcomes, followed by waterpipe and e-cigarette use.…
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