الفهرس 
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Abstract
The cumulative negative synergistic effect resulted from the association between smoking impact and poor bone quality presented in posterior maxilla has introduced a serious motivation of authors toward using an innovative Direct Laser Metal Sintering (DLMS) technology applied in implant production to improve implant success rate in such troublesome condition. So, this study was directed to evaluate the impact of smoking on clinical outcomes of early loaded DLMS implants used in posterior maxilla. Patients and Methods Twenty patients including six non-smokers within group (A) and 14 smoking patients were involved in this study representing three separate groups. All the other fourteen patients were subdivided into two equal separate harmoniously distributed groups; either mild (1- 19 pack-years) or moderate smoking (20-39 pack-years) according to the heaviness of smoking rate. All patients within this study received DLMS dental implant installed in the posterior maxillary region and were subjected to early loading modality within 6-8 weeks. All patients were evaluated clinically at regular time intervals either immediately, at 6 and 12 months postoperatively regarding to implant stability, periodontal probing depth, Modified sulcus bleeding Index (mSBI) and marginal bone loss (MBL).Results Comparing all groups, no statistical significant difference was recorded immediately after placement of final crown (P=0.366-0.104) while, a statistical significant differences were recorded between all groups after 6 and 12 months (P= 0.033-0.001) regarding to implant stability and peri-implant pocket depth. Regarding to (mSBI) a statistical significant differences were recorded between all group at the time of initial loading, 6 and 12 month (P=0.021-0.043-0.023) respectively. Only within group (C), regarding the marginal bone loss, marked statistical significant differences were recorded during comparing subsequent time intervals of follow up against each other (P=0.0004-0.0002-0.005) respectively. Conclusio Although, the reversible smoking impact was represented as a relative contraindicating condition of implant surgery, the emergence of DLMS implants has introduced an additional positive prognostic effect on implant success especially, in compromised situations such as poor bone quality and variable loading time protocols.