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Available evidence
vs. 15.2%, implant level analysis) was observed when deep residual pockets were present (Cho-Yan Lee et al., 2012).
Number and design of included studies Four studies, including three case – control studies and one cohort study (Carra et al., 2023). Clear similarities between the three case – control studies conducted by the same research team were noted. Risk of bias According to NOS, the three case – control studies were at high risk of bias, and the cohort study was at low risk of bias. Effect sizes and their clinical relevance Only one study described the occurrence of peri-implant diseases as a clinical diagnosis, reporting a lower rate of peri-implant muco- sitis (43.9% vs. 48.6%) and peri-implantitis (19.7% vs. 30.5%) in for- mer smokers compared with current smokers (Costa et al., 2022). The authors observed a direct association between cumulative smoking exposure and the risk for peri-implantitis, as well as with the time span since smoking cessation. All studies reported significant clinical differences between for- mer smokers, e-cigarette users, waterpipe smokers and current smokers. The former smoker category exhibited less peri-implant mucosal inflammation, PD and MBL compared with the other categories. Consistency There is insufficient evidence to determine whether cigarette smoking cessation decreases the risk for peri-implant diseases. There is little evidence to support the contention that using e-cigarettes or the habit of water pipe smoking is associated with a decreased risk for peri-implant diseases compared with cigarette smoking. Balance of benefit and harm Not assessed. However, because of the several harmful consequences of smoking, smoking cessation should be advised and promoted for every patient irrespective of implant therapy. Overall certainty of the evidence Low. No interventional studies were found to provide direct evi- dence. The results are inferred from studies with various working hypotheses that were not originally developed to test the effective- ness of smoking cessation on the occurrence of peri-implant dis- eases. Further research is very likely to have an impact on confidence in the estimate of the effects of cigarette cessation on the reduction of the risk of incident peri-implant diseases. Regard- ing the use of non-cigarette smoking, any estimate of effect is very uncertain.
Consistency All selected studies were overall consistent, favouring regular SPIC over irregular SPIC. Balance of benefit and harm Not assessed. However, the importance and clinical relevance of SPIC should be reinforced, given that regular SPIC carries little risk compared with the benefits it brings. Overall certainty of the evidence Moderate. Results are inferred from studies with various working hypotheses that were not originally developed to test the effective- ness of a preventative measure on the occurrence of peri-implant diseases. Further research, including clinical trials with strict inclu- sion criteria, may have an impact on confidence in the estimated effect of regular versus irregular SPIC on the risk of peri-implant diseases.
From evidence to recommendation — additional considerations
Not applicable.
R5.7. In patients who smoke and have healthy peri- implant tissues, does the cessation of cigarette smoking reduce the risk of incident peri-implant diseases?
PICOS question addressed by an SR
R5.7: Expert consensus-based recommendation In patients with healthy peri-implant tissues, we recommend validated smoking cessation interventions (by conformance with guidelines) to reduce the risk of peri-implant diseases . Supporting literature (Carra et al., 2023) Quality of evidence Very low Grade of recommendation GradeA — "" Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
From evidence to recommendation — additional considerations
Intervention
The risk factor is smoking, and the preventive intervention is promo- tion of smoking cessation advice/strategies.
Not applicable.
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