Epidemiology and Health

Original Articles

Association between smoking and the risk of dental implant failure in Korean adults: a nationwide cohort study: Yu-Rin Kim, Minkook Son, Hyeon Ji Kim, Seon-Rye Kim; Epidemiol Health. 2026;48:e2026002. Published online January 14, 2026; DOI: https://doi.org/10.4178/epih.e2026002

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We evaluated the associations of smoking status, intensity, duration, and cumulative exposure with the risk of dental implant failure in Korean adults.
METHODS
This retrospective cohort study utilized the National Health Insurance Service–Health Screening Cohort (2016–2019). Overall, 23,573 individuals who had completed the dental implant process were included. Smoking status was categorized as non-smoker, ex-smoker, or current smoker. Smoking intensity, duration, and cumulative exposure were classified using standardized thresholds (>10 cigarettes per day, >10 years, and >10 pack-years). Implant failure was defined as reimplantation or removal. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, clinical, and behavioral covariates.
RESULTS
During follow-up, 605 implant failures occurred: 344 in non-smokers, 182 in ex-smokers, and 79 in current smokers. The corresponding incidence rates per 1,000 person-years were 11.56, 16.54, and 22.33, respectively. Current smoking was significantly associated with higher implant failure risk (adjusted HR, 1.59; 95% CI, 1.20 to 2.09), while ex-smokers displayed a non-significant increase (adjusted HR, 1.16; 95% CI, 0.94 to 1.45). A dose–response relationship was observed: smoking more than 10 cigarettes per day, smoking for more than 10 years, or exceeding 10 pack-years was associated with significantly increased risk.
CONCLUSIONS
Smoking is a significant, dose–dependent risk factor for dental implant failure in Korean adults. Current smokers have the highest risk; smoking cessation may reduce adverse outcomes. These findings emphasize the importance of detailed smoking assessments and cessation counseling in implant care and public health strategies.; Summary

Korean summary
본 연구는 치아 임플란트를 시행한 성인들을 대상으로 흡연 상태(현재, 과거, 비흡연)와 흡연 강도, 기간, 누적 노출량에 따른 임플란트 실패 위험의 차이를 분석하였다. 분석 결과, 비흡연자에 비하여 현재 흡연자, 하루 10개피 이상 흡연자, 10년 이상 장기 흡연자, 10갑년 이상 누적 흡연자에서 임플란트 실패 위험이 유의하게 높았다. 특히, 여성의 경우 흡연이 임플란트 실패에 미치는 영향이 남성보다 크게 나타났다. 반면, 과거흡연자는 통계적으로 유의한 연관성을 보이지 않았다. 이러한 결과는 구강건강 증진과 임플란트의 성공적 예후를 위해 흡연자의 금연지도가 필수적임을 시사한다.

Key Message
This study examined differences in implant failure risk according to smoking status (current, former, never) and smoking intensity, duration, and cumulative exposure among adults who underwent dental implant placement. Compared with never-smokers, the risk of implant failure was significantly higher in current smokers, those who smoked ≥10 cigarettes/day, long-term smokers (≥10 years), and individuals with ≥10 pack-years of cumulative smoking exposure. Notably, the adverse impact of smoking on implant failure was greater in women than in men. In contrast, former smoking was not statistically associated with implant failure. These findings underscore the need for structured smoking-cessation counseling to improve oral health and optimize implant prognosis.

Dental implant removal rates and related factors in older adults in Korea: a cross-sectional study using National Health Insurance Sharing Service database: Hyang-Ah Park, A-Rang Lim, Jae-In Ryu; Epidemiol Health. 2025;47:e2025064. Published online December 3, 2025; DOI: https://doi.org/10.4178/epih.e2025064

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Abstract Summary PDF: Abstract
OBJECTIVES
Dental implants have been covered by the National Health Insurance for older adults in Korea since 2014. As the number of implant treatments has increased, the occurrence of related complications has also grown. While many clinical studies have examined mechanical and biological complications, few epidemiological studies using national data have identified population-level risk factors. This study aimed to determine the dental implant removal rate and related factors among older adults based on the Andersen Behavioral Model.
METHODS
A cross-sectional analysis was conducted using the National Health Insurance Service–National Sample Cohort. Logistic regression analyses were performed to identify factors associated with implant removal. Unadjusted and stepwise cumulative models were applied for predisposing, enabling, and need factors. All analyses were conducted using SPSS version 26.0, with statistical significance set at α=0.05.
RESULTS
The overall dental implant removal rate among older adults was approximately 0.4%. Higher removal rates were observed among males, those aged 65-69, current smokers, individuals with diabetes, and the self-employed group with higher income levels. Current smokers had 1.75 times higher odds of implant removal (95% confidence interval, 1.39 to 2.22) than non- smokers or former smokers.
CONCLUSIONS
Targeted education, management, and preventive interventions for high-risk groups, including smokers and patients with diabetes, are necessary to improve implant success and reduce complications. These findings provide population- based evidence to inform public health strategies that promote successful implant outcomes among older adults.; Summary

Korean summary
이 연구는 국가 단위의 빅데이터 코호트를 이용해 치과 임플란트 제거에 관해 시행한 선행 연구가 없었기 때문에 국가 빅데이터를 활용해 치과 임플란트 제거율과 관련 요인을 파악하기 위해 Anderson Model을 기반으로 다요인 분석을 실시하였다. 전체 치과 임플란트 제거율은 약 0.4%였으며, 남성, 젊은 연령, 건강보험 가입자, 상위 소득분위 자영업자, 당뇨병, 흡연, 유산소 신체 활동 실천자에서 더 높게 나타났다. 특히 현재 흡연자인 경우 치과 임플란트 제거율을 경험할 확률이 1.8배 높았다. 따라서, 치과 임플란트 시술의 성공률을 높이기 위해서는 위험요인에 대해 명시한 가이드라인 제작이 필수적이다.

Key Message
This study conducted a multifactorial analysis based on the Andersen model to identify factors associated with dental implant removal using national big data, addressing the lack of prior studies that examined these determinants sufficiently. The dental implant removal rate among all subjects was approximately 0.4%, and higher removal rates were observed among men, younger individuals, those receiving medical benefits, the self-employed group with higher income quintiles, and individuals with diabetes, smoking habits, or engagement in aerobic physical activity. Current smokers had a 1.8-fold higher probability of implant removal. These findings reinforce the importance of developing and implementing guidelines to increase the success rate of dental implants.

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