The objective of this practice-related study was to investigate the performance of the DENTAL RATIO Implant System in heavy smokers with over 20 cigarettes per day. Non-smokers were used as control group. Two implants did not show primary stability in the smoker group which equals a failure rate of 5 %. All implants were osseointegrated in the non-smoker group. There were no significant differences in age and gender of the patients. From a relative point of view, the loss rate of 5% shows that smokers can certainly be provided with implants as long as an appropriate strict protocol is adhered to.