Purpose: The present study evaluated the effect of smoking on achieving initial osseointegration when surface-modified dental implants were used. Materials and Methods: During an 18-month period in a private practice setting, 1,183 implants were placed in 461 patients. The group of smokers consisted of patients who smoked a half pack or more of cigarettes per day. Results: The overall success rate for smokers and non-smokers in achieving osseointegration was 98.1%. Ninety-seven percent of the implants placed in smokers osseointegrated successfully, and 98.4% of implants placed in non-smokers osseointegrated successfully (P .05). Discussion: The surface of an implant may be a critical determinant for achieving osseointegration in patients who smoke. Conclusion: It appears from this short-term retrospective study that smoking does not play a significant role in achieving the osseointegration of surface-modified dental implants.