Cigarette smoking negatively affects healing response following flap debridement surgery

Background: The purpose of the present parallel design, controlled clinical trial was to evaluate the treatment outcome following flap debridement sur gery (FDS) in cigarette smokers compared to non-smokers. Methods: After initial therapy, 57 systemically healthy subjects with moder ate to advanced periodontitis who presented with one area (at least 3 teeth ) where surgery was required were selected. Twenty-eight patients (mean age : 39.6 years, 20 males) were smokers (greater than or equal to 10 cigarette s/day); 29 patients (mean age: 43.9 years, 7 males) were non-smokers. Full- mouth plaque (FMP) and bleeding on probing (BOP) scores, probing depth (PD) , clinical attachment level (CAL), and recession depth (RD) were assessed i mmediately before and 6 months following surgery. Only sites with presurger y PD greater than or equal to4 mm were used for statistical analysis. Results: Presurgery FMP and BOP were similar in smokers and non-smokers and significantly decreased postsurgery in both groups. Overall, PD reduction and CAL gain were greater, although not significantly, in non-smokers (2.4 +/- 0.9 mm and 1.6 +/- 0.7 mm, respectively) than in smokers (1.9 +/- 0.7 m m and 1.2 +/- 0.7 mm, respectively). For moderate sites (PD 4 to 6 mm), no significant differences in PD and CAL changes were found between groups. Fo r deep sites (PD greater than or equal to7 mm), PD reduction was 3.0 +/- 1. 0 mm in smokers and 4.0 +/- 0.8 mm in non-smokers, and CAL gain amounted to 1.8 +/- 1.1 mm in smokers and 2.8 +/- 1.0 mm in nonsmokers (P = 0.0477). I n smokers, 16% of deep sites healed to postsurgery PD values less than or e qual to3 mm as compared to 47% in non-smokers (P = 0.0000); 58% of deep sit es in smokers showed a CAL gain greater than or equal to2 mm, as compared t o 82% in non-smokers (P = 0.0000). Conclusions: Results of the study indicated that: I) FDS determined a stati stically significant PD reduction and CAL gain in patients with moderate to advanced periodontitis; 2) smokers exhibited a trend towards less favorabl e healing response following FDS compared to non-smokers, both in terms of PD reduction and CAL gain; and 3) this trend reached clinical and statistic al significance at sites with initial deep PD.