Implant Surface Characteristics and Peri-Implant Outcomes: A Systematic Review of Clinical and Microbiological Evidence

Background: Implant surface characteristics have been extensively investigated for their\r\npotential influence on osseointegration and peri-implant tissue stability. However, their\r\nactual clinical relevance in the prevention and progression of peri-implant diseases remains\r\ncontroversial. This systematic review aimed to synthesize the available clinical\r\nand microbiological evidence on the impact of different implant surface characteristics\r\nand surface modifications on peri-implant outcomes. Materials and Methods:\r\nConducted according to PRISMA and registered in PROSPERO, an electronic search of\r\nPubMed, Scopus, and Web of Science (2015–2025) identified clinical studies assessing associations\r\nbetween implant surface characteristics/modifications and peri-implant clinical,\r\nradiographic, microbiological, or biomolecular outcomes. Risk of bias was evaluated\r\nusing ROBINS-I. Results: Thirteen studies (randomized, controlled, and cohort designs)\r\nwere included. Most trials reported minimal differences in marginal bone loss and periimplant\r\nparameters across surfaces. Potential advantages were mainly observed during\r\nearly healing or in compromised bone. Long-term evidence emphasized the predominance\r\nof patient- and site-related risk factors. Microbiological outcomes were scarce and\r\nheterogeneous. Conclusions: Implant surface modifications appear to exert a limited\r\nand context-dependent influence on peri-implant outcomes. Long-term peri-implant\r\nhealth is primarily driven by multifactorial interactions involving host, microbial, and\r\nclinical factors rather than surface characteristics alone.