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Smoking is a risk factor for periodontal disease and periodontal surgery is often required to bring about improvements in probing depth (PD). Studies have suggested poorer outcomes from periodontal treatment in smokers. The aim of this review is to assess the impact of cigarette smoking on the clinical outcomes following periodontal surgery procedures (flap debridement surgery, modified Widman flap, apically positioned flap).


Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases. This was supplemented by hand searches of the journals; Journal of Clinical Periodontology, Journal of Periodontology, The International Journal of Periodontics & Restorative Dentistry, and Journal of Periodontal Research. Controlled studies with more than 10 patients comparing surgical interventions that included flap debridement surgery, modified Widman flap, and apically positioned flap procedures in smokers and non-smokers with 6 months or longer follow up were considered.

Two reviewers independently screened the studies, extracted data and carried out quality assessment. Study quality was assessed using the Consolidated Standards of Reporting Trials (CONSORT) statement criteria Meta-analyses were conducted separately for each of the two primary outcomes, probing depth (PD) and clinical attachment level (CAL) using a random-effects model.

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