Background: The purpose of this study was to compare the incidence of the complications and survival rate related to dental implants among smokers and non‐smokers, and to evaluate the influence of smoking by analyzing data of 959 implants placed in 261 patients during the years 1995 to 1998.Methods: Patients were divided into 3 groups: non‐smokers, mild smokers (up to 10 cigarettes per day) and heavy smokers (more than 10 cigarettes per day); smokers were divided into 2 subgroups according to duration of smoking (less or more than 10 years). Complications included minor (spontaneous implant exposure), major (spontaneous implant exposure requiring surgical intervention), and implant failure. The influence of smoking was analyzed for the type of implant cover screw and immediate versus late implantation.Results: The overall failure rate was 2% for non‐smokers and 4% for all smokers. Minor and major complications were found in higher percentages (46%) in the smoking groups than in the non‐smoking group (31%). A significantly higher incidence of complications was found among smokers who received dental implants with high cover screws (63%) compared to those who received dental implants with flat cover screws (27%).Conclusions: This study establishes a relationship between implant complications and smoking, implant type (external or internal hex), and time of implantation as significant factors. A higher incidence of complications was found in the smoking group, especially in implants that had a high cover screw. Most complications will not lead to failures. Immediate implants failed less frequently than non‐immediate implants. Limiting or reducing smoking habits will decrease complications of endosseous dental implants. J Periodontol 2002;73:153‐157.