Cigarette smoking has long been suspected to adversely effect wound healing. Review of our experiences with impaired wound healing in patients undergoing intraoral bone grafting and simultaneous implant placement implicated smoking as a potentially significant risk factor. Fifteen consecutive adult patients (5 smokers and 10 nonsmokers) who underwent intraoral bone grafting with simultaneous implant placement were retrospectively reviewed. Five of 15 patients experienced impaired wound healing defined as loss of bone and/or implants. Four of these five (80%) admitted to smoking in the perioperative period. One of 10 nonsmokers experienced problematic healing (10%). Although other factors may have played a role, cigarette smoking is a potentially controllable risk factor strongly associated with problem wounds in this series of patients. Evidence implicating smoking as a risk factor is presented and discussed.