Front. Dent. Med. Frontiers in Dental Medicine Front. Dent. Med. 2673-4915 Frontiers Media S.A. 10.3389/fdmed.2025.1661369 Dental Medicine Systematic Review Impact of implant surface modifications on long-term outcome of surgical peri-implantitis treatment: a systematic review GardelisPanagiotis 1 GiannopoulouCatherine 1 StavropoulosAndreas 2 3 4 5 ZekeridouAlkisti 1 * Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden Department of Periodontology, Blekinge Hospital, Karlskrona, Sweden Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland

Edited by: Giuseppe Troiano, University of Foggia, Italy

Reviewed by: Rok Gašperšič, University of Ljubljana, Slovenia

Patricia Miguez, University of North Carolina at Chapel Hill, United States

Matteo Serroni, G. d'Annunzio University of Chieti and Pescara, Italy

 Correspondence: Alkisti Zekeridou alkisti.zekeridou@unige.ch 24092025 2025 61661369 07072025 05092025 © 2025 Gardelis, Giannopoulou, Stavropoulos and Zekeridou. 2025Gardelis, Giannopoulou, Stavropoulos and Zekeridou

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

 Introduction

Peri-implantitis is an inflammatory disease that compromises peri-implant tissues and supporting bone, potentially leading to implant loss. Although several surgical treatment strategies have been proposed, it remains unclear whether implant surface characteristics (smooth vs. rough) influence long-term treatment outcomes.

Methods

A systematic review was conducted to evaluate clinical studies with a minimum follow-up of 3 years that assessed the outcomes of surgical treatment of peri-implantitis in relation to implant surface type. Data extraction focused on recurrence of peri-implantitis, implant survival, clinical parameters, radiographic outcomes, and the type of surgical approach used (reconstructive vs. non-reconstructive).

Results

Seventeen clinical studies were included. Outcomes varied according to implant surface characteristics. Rough (modified) surfaces were generally associated with a higher risk of recurrence of peri-implantitis and implant loss compared with smooth (machined/turned) surfaces. Reconstructive surgical approaches, especially those involving bone grafts and membranes, demonstrated more favorable outcomes compared with non-reconstructive approaches.

Discussion

Despite observed trends, the certainty of the evidence remains low due to heterogeneity between studies, small sample sizes, and methodological limitations. Further well-designed long-term clinical trials are needed to clarify the role of implant surface characteristics in the long-term success of peri-implantitis surgical treatment.

Systematic Review Registration

PROSPERO (CRD420251129791).

 peri-Implantitis surgical peri-implantitis treatment treatment outcome explantation implant surface long-term outcomes bone loss implant survival section-at-acceptancePeriodontics Introduction

Dental implants have significantly advanced oral rehabilitation, providing highly predictable solutions for tooth replacement. For instance, a recent systematic review reported that long-term prospective studies on dental implants show high survival rates, typically exceeding 90% over 5–10 years and remaining around 78% after imputation at 20 years follow-up. In addition, five retrospective studies with ≥20 years of follow-up reported an implant survival rate of approximately 88%, including multifactorial causes (1).

However, despite the high survival rates, biological complications at implants are rather common. In particular, peri-implantitis, which is characterized by peri-implant mucosal inflammation and progressive bone loss, affects approximately 19.53% of patients and 12.53% of implants, highlighting its relevance in clinical practice (2). As the main etiological factor for peri-implantitis is the oral biofilm, microbial to implant surface interactions seem to play an important role in disease pathogenesis. Indeed, surface modifications (e.g., sandblasting, acid-etching, anodization, etc) aiming in enhancing implant surface bioactivity, substantially impact on microbial colonization and biofilm development (3–7). Indeed, although the incidence of peri-implantitis seems not to differ between modified and non-modified (i.e., turned) implants in the clinic, progression and severity of peri-implantitis appear linked to implant surface properties; specifically, pre-clinical in vivo studies indicate a faster disease progression at modified implants compared with turned implants, as well as differences in disease progression among various modified surfaces (5, 7). Moreover it seems that implant surface characteristics may impact on treatment outcomes both in the short-term but also on the long-term, with implants with a modified surface demonstrating less positive results and higher recurrence rates (3, 8, 9).

Despite technological advancements and improved treatment approaches, the impact of implant surface modifications on peri-implantitis outcomes remains unclear. Therefore, this systematic review aims to evaluate whether varying implant surface topographies influence clinical and radiographic outcomes following surgical peri-implantitis treatment in humans. The findings may offer critical insights guiding the selection of implant surface characteristics to enhance treatment efficacy.

 Materials and methods Study design

This review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (ID: CRD420251129791).

 Search strategy

To identify relevant studies, we systematically searched PubMed, Embase, and the Cochrane Library. The search strategy was carried out in English language from database inception for articles published between 2000 and 2025. Two investigators (AZ and PG) independently reviewed the search results and screened the titles and abstracts. Full texts of all potentially eligible studies were obtained. In PubMed, the following search strategy was used: “(Periimplantitis OR peri-implantitis OR peri implantitis OR periimplant OR peri-implant OR peri implant) AND (treatment outcome OR therapy OR surgical treatment OR regenerative OR regeneration OR tissue regeneration OR reconstructive surgery OR bone graft OR bone substitute OR membranes OR surgical flap OR open flap debridement OR resective OR implantoplasty OR surface decontamination) AND (surface characteristics OR surface roughness OR material characteristics OR titanium surface OR implant types OR implant surfaces OR surface topography OR surface analysis) AND (implant survival OR bone loss OR recurrence OR retreatment OR radiographic stability OR long-term OR 3 years OR follow-up).” This search strategy was adapted to suit the other electronic sources. The reference lists of retrieved articles were also checked to identify additional studies of interest. Any inconsistencies were resolved by consensus with a third investigator (CG). The complete search strategies for all databases are provided in Appendix 2.

 Criteria for considering studies for this review Study design

Randomized controlled trials, prospective studies, retrospective studies, case-control studies, and case series were included. No specific cut-off criteria for sample size were applied, given the limited availability of data. Additionally, two case series with very small sample sizes were included due to their clinical relevance. Eligibility required that included studies explicitly reported the implant surface type(s) of the implants investigated.

 Population

Human studies. Patients with osseointegrated dental implants diagnosed with peri-implantitis, treated surgically, with a follow-up period of at least 3 years (or an average ≥3 years).

 Intervention

Surgical therapy for peri-implantitis.

 Comparator

Different implant surface types, characterized by variations in macro-, micro-, and nano-scale surface roughness, topography, and material composition. Surfaces were categorized as non-modified (i.e turned, smooth, machihed), modified (rough), or mixed (hybrid), depending on their reported surface characteristics.

 Outcomes Primary outcome

Percentage of implants with recurrence of peri-implantitis requiring re-treatment or explantation or simply defined as treatment failure by the authors.

 Secondary outcomes

Implant loss (due to any reason)

Disease resolution defined by reduction of probing depth (PD) without bleeding on probing (BOP) or suppuration

Radiographic bone loss or gain assessed by mean changes in bone levels or percentage of implants with stable bone levels post-treatment

Mean probing depth (PD) post-treatment

Subgroup synthesis: The outcomes were further stratified based on implant surface types and surgical approach:

Turned (machined/non-modified surfaces)

a. Non-reconstructive surgical approach

b. Reconstructive surgical approach (regardless the technique or materials used)

Modified (rough surfaces)

a. Non-reconstructive surgical approach

b. Reconstructive surgical approach (regardless the technique or materials used)

Mixed or unspecified surfaces

a. Non-reconstructive surgical approach

b. Reconstructive surgical approach (regardless the technique or materials used)

Data collection

Two investigators independently extracted key data from the included articles. The inter-rater agreement for study selection was assessed using Cohen's kappa statistics. Inter-rater reliability was assessed using Cohen's kappa statistic on a subset of 20% of studies, yielding a kappa of 0.85, indicating a high level of agreement. Discrepancies were resolved through discussion or consultation with a third reviewer (CG). For each article, we extracted study features (i.e., study design, year of publication, number of enrolled patients), type of intervention, and outcome measures. Correct data extraction was controlled in a subset of randomly selected studies by the third investigator.

 Assessment of risk of bias

Two investigators independently appraised the risk of bias of the included studies using the Cochrane Risk of Bias Tool 2.0 (RoB2) for RCTs. For non-RCTs the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used. Any inconsistencies were resolved by consensus with a third investigator (CG).

 Data synthesis

Preliminary analyses of available data revealed high heterogeneity, precluding meaningful meta-analysis. Therefore, a narrative synthesis was conducted. These limitations included significant heterogeneity in implant surface types, surgical techniques, and reported outcome measures across studies. To enhance clarity and readability, findings were systematically summarized in tables according to pre-defined outcomes and subgroup analyses.

Data extraction was performed separately for each treatment group within studies containing multiple groups, while data from studies with a single treatment group were extracted accordingly. Results were categorized based on implant surface types and surgical approaches as follows:

Turned (machined/non-modified surfaces) a. Non-reconstructive surgical approach b. Reconstructive surgical approach (regardless the technique or materials used)

Modified (rough surfaces) a. Non-reconstructive surgical approach b. Reconstructive surgical approach (regardless the technique or materials used)

Mixed or unspecified surfaces a. Non-reconstructive surgical approach b. Reconstructive surgical approach (regardless the technique or materials used)

 Findings were systematically summarized in tables according to pre-defined outcomes and subgroup analyses to enhance clarity and readability.

Within each treatment group, data were systematically collected on key parameters, including sample size (number of participants and implants), criteria used to define peri-implantitis, type of bone substitute, membrane used (if applicable), follow-up periods, implant system, and implant surface characteristics.

 Results Study selection

The literature search process is illustrated in the flowchart below (Figure 1). In total, there are 17 studies included in the analysis (8–24). Among them, 8 are prospective cohort studies, 3 are retrospective cohort studies, 1 are randomized controlled trials. The remaining studies include 1 each of the following types: prospective clinical study, retrospective observational study, and prospective case series. A detailed description of the study characteristics can be found in the results in Tables 1a,b.

PRISMA flow diagram.

Flowchart detailing the identification and inclusion of new studies. Begins with 3,070 records from databases. After removing 909 duplicates, 2,161 records are screened. 2,121 are excluded. Forty reports are sought, with none excluded at this stage. Assessing eligibility, 23 reports are excluded due to study duration (4), design (2), outcome (3), or implant surface not applicable (14). Seventeen new studies are included in the review.

Summary of clinical studies evaluating treatments of peri-implantitis: surface types, materials, and outcomes.

Author (year) Implant surface Implant brand Patients (initial/follow-up) Implants (initial/follow-up) Type of treatment Materials used Follow-up period Surface impact
Aghazadeh et al. (2022) (32)

Mixed (Turned and medium-rough)

Not explicitly stated, categorized by surface type

45 (AB:22/16, BDX:23/23)

75 (AB:36/25, BDX:39/38)

Reconstructive surgery (autogenous bone, xenograft, collagen membrane)

Autogenous bone, xenograft (Bio-Oss), collagen membrane (OsseoGuard), titanium curettes, hydrogen peroxide, azithromycin, CHX rinse

5 years

No significant difference (turned vs. medium-rough surfaces)
Carcuac et al. (2020) (15)

Mixed (modified/non-modified)

Not specified, classified as non-modified/modified

100/73

179/130

Open-flap debridement, surface decontamination, pocket elimination

Systemic antibiotics, local antiseptics

5 years

Modified surfaces higher recurrence risk (OR 5.1, 95% CI: 1.6–16.5)
Deppe et al. (2007) (18)

Mixed (rough predominantly)

IMZ, Frialit-2, Brånemark, Straumann screw-type

32

73 (Conventional:34, Laser:39)

Conventional vs. CO₂ laser-assisted (soft tissue resection/augmentation)

CO₂ laser, air-powder abrasive, β-TCP/autogenous bone, Gore-Tex membrane

5 years

Superior outcomes with CO₂ laser in non-reconstructive therapy
Jemt & Eriksson (2021) (19)

Mixed (Turned and moderately rough surfaces)

Brånemark (turned), TiUnite, Astra Tech OsseoSpeed, Lifecore RBM

122 (initially 134, 12 lost)

614/453

Non-reconstructive surgery (mechanical cleaning, osseous recontouring, antibiotics)

Mechanical debridement, hydrogen peroxide 10%, systemic antibiotics

Mean 7.3 years

No significant difference (turned vs. moderately rough surfaces)
Khoury & Buchmann (2001) (20)

Rough surfaces

IMZ, Frialit-2 (Friadent GmbH)

25

41

Reconstructive surgery (autogenous bone ± membranes)

Autogenous bone, ePTFE/Bioabsorbable barriers, CHX, citric acid, hydrogen peroxide, systemic antibiotics

3 years

No surface comparison (all rough)
La Monaca et al. (2024) (22)

Rough (TiUnite surface)

Nobel Biocare (Brånemark System, Göteborg)

34/23

34/20

Reconstructive surgery (MDBA, resorbable membrane, chemical/mechanical decontamination)

MDBA (Puros), collagen membrane (Bio-Gide), hydrogen peroxide, CHX solution, tetracycline hydrochloride, systemic antibiotics (Amox/clav, Metronidazole)

10 years

All rough (TiUnite); no surface-specific comparison
La Monaca et al. (2018) (21)

Rough (TiUnite surface)

Nobel Biocare (Brånemark System, Göteborg)

34

34

Reconstructive surgical therapy (MDBA, resorbable collagen membrane, chemical/mechanical decontamination)

MDBA (Puros), resorbable membrane (Bio-Gide), hydrogen peroxide, CHX 0.2%, tetracycline hydrochloride, systemic antibiotics

5 years

All rough (TiUnite); no surface comparison
Leonhardt et al. (2003) (23)

Turned surfaces

Brånemark System (Nobel Biocare)

9

26

Surgical non-reconstructive therapy + systemic antibiotics

Hydrogen peroxide 10%, individualized antibiotics (metronidazole, amoxicillin, tetracycline, ciprofloxacin, clindamycin), CHX rinse

5 years

All turned surfaces; not directly analyzed
Mercado et al. (2018) (24)

Rough (Micro-rough)

Branemark TiUnite (46.66%), Astra Tech (26.66%), Straumann (10%), Others (16.66%)

30

30

Regenerative surgery (DBBMC, EMD, doxycycline, EDTA, ultrasonic scaler)

DBBMC, EMD, doxycycline, EDTA 24%, ultrasonic scaler, chlorhexidine 0.12%

36 months

Not specifically analyzed (micro-rough surfaces)
Noelken et al. (2023) (25)

Mixed (rough predominantly)

Straumann, Ankylos, Brånemark, NobelActive, NobelPerfect, Frialit I, OsseoSpeed, Camlog, ICX

18

24

LAPIDER (laser-assisted regeneration, autogenous bone, CT graft)

Er:YAG laser, autogenous bone chips, doxycycline, CT graft, resorbable sutures

3 years

No direct comparison; rough surfaces only
Roccuzzo et al. (2017) (26)

Rough (SLA and TPS)

Straumann (SLA, TPS)

26/24

26/24

Regenerative surgery (DBBMC, EDTA, CHX)

DBBMC (Bio-Oss Collagen), EDTA 24%, CHX gel 1%, antibiotics (Amoxicillin/clavulanic acid)

7 years

SLA better clinical outcomes than TPS (significant)
Roccuzzo et al. (2020) (27)

Rough (SLA and TPS)

Straumann (SLA, TPS)

26/14

26/14

Regenerative surgery (DBBMC, EDTA, CHX)

DBBMC (Bio-Oss Collagen), EDTA 24%, CHX gel 1%, antibiotics (Amoxicillin/clavulanic acid)

10 years

SLA superior survival/outcomes compared to TPS
Roccuzzo et al. (2021) (28)

Rough (SLA)

Straumann (SLA implants)

75/51

75/64

Reconstructive surgery (DBBMC, EDTA, CHX gel, titanium curettes, connective tissue graft)

DBBMC, EDTA 24%, CHX 1% gel, titanium curettes, titanium brush, connective tissue graft, systemic antibiotics

5 years

Uniform (all SLA surfaces)
Romandini et al. (2024) (16)

Mixed (Turned and Modified)

Nobel Biocare (74.2%), Astra Tech (18%), Straumann (6.7%), Neoss (1.1%)

149

267

Non-reconstructive surgical therapy (titanium-coated curettes, systemic antibiotics)

Titanium-coated curettes, saline/CHX gauze, selective systemic antibiotics (Amoxicillin)

Mean 7 years (range 1-18 years)

Modified surfaces significantly higher implant loss risk (HR = 4.5)
Roos-Jansåker et al. (2011) (29)

Primarily machined, few modified (rough)

Brånemark (majority), Astra Tech (minority)

38/32

65/56

Reconstructive surgery (Algipore ± membrane)

Algipore, Osseoquest membrane, H₂O₂ 3%, antibiotics (amoxicillin, metronidazole), CHX 0.1% rinse

3 years

No significant impact reported (mostly machined)
Roos-Jansåker et al. (2014) (30)

Primarily machined, few modified (rough)

Brånemark (majority), Astra Tech (minority)

38/25

Not initially specified/45

Reconstructive surgery (Algipore ± membrane)

Algipore, Osseoquest membrane, H₂O₂ 3%, antibiotics (amoxicillin, metronidazole), CHX rinse

5 years

No significant impact (mostly machined surfaces)
Schwarz et al. (2009) (31)

Mixed (machined and rough surfaces)

Brånemark, Camlog, ITI, KSI Bauer Schraube, Zimmer, ZL-Duraplant

22/19

22/19

Regenerative surgery (NBM + CM vs. NHA)

NBM (BioOss), CM (BioGide), NHA (Ostim), plastic curettes, CHX 0.2%

48 months

Surface-specific outcomes not detailed

Comparative outcomes of clinical studies on peri-implantitis treatments: implant surfaces, secondary outcomes, and long-term surface impact.

Author (year) Implant loss (%) Disease resolution Radiographic bone loss/gain Mean PD post-treatment Subgroup analysis (by surface & approach) Conclusions surface impact
Aghazadeh et al. (2022) (32)

AB: 1 fractured, BDX: 1 fractured (both initially)

PD reduction AB: 1.7 mm, BDX: 2.8 mm at 5 years

AB: −0.7 mm (loss), BDX: + 1.6 mm (gain)

AB: PD reduced by 1.7 mm, BDX: by 2.8 mm at 5 years

BDX superior to AB; reconstructive approach only, no surface-specific outcomes detailed

BDX superior to AB; supportive maintenance every 3 months emphasized.

No significant difference (turned vs. medium-rough surfaces)
Carcuac et al. (2020) (15)

20.8%

Not explicitly combined; PD ≥ 6 mm at 1 year = increased recurrence (OR 7.4)

Stable from year 1; further loss >1 mm in 13.1%

5.0 mm (stable from year 1 at 4.9 mm)

Non-modified: 17% recurrence, Modified: 52% recurrence; no explicit surgical subgroup

Surgical treatment effective, but 44% recurrence; modified surfaces, deep residual PD major risk factors.

Modified surfaces higher recurrence risk (OR 5.1, 95% CI: 1.6–16.5)
Deppe et al. (2007) (18)

17.8%

Superior PD reduction laser (1.0–2.4 mm at 4 months)

Laser better short-term bone gain; long-term similar outcomes

Laser: 1.0–2.4 mm, Conventional: 2.4–7.9 mm (long-term)

Laser superior in soft tissue resection; similar in augmentation

Laser beneficial in non-reconstructive procedures; similar long-term results in augmentation.

Superior outcomes with CO₂ laser in non-reconstructive therapy
Jemt & Eriksson (2021) (19)

16.7%

Not explicitly reported; primarily bone-level outcomes

Increased bone loss post-treatment (0.26 mm/year)

PD not explicitly reported

No significant differences between surface types; increased bone loss post-treatment

Surgical treatment ineffective long-term; bone loss accelerated post-treatment, edentulous worse prognosis.

No significant difference (turned vs. moderately rough surfaces)
Khoury & Buchmann (2001) (20)

0% explicitly reported

PD improvement: Bone alone 8.0→2.9 mm, worse with membranes (7.7→5.1 mm)

Significant bone gain (bone alone 3.2 mm, membranes lower)

Bone alone: 2.9 mm; Non-resorbable: 2.8 mm; Bioabsorbable: 5.1 mm

Bone alone superior; membranes caused high complications

Bone grafting alone effective; membranes did not enhance outcomes, increased complications.

No surface comparison (all rough)
La Monaca et al. (2024) (22)

8.8%

Composite success: 53%, PD significantly reduced to 2.95 mm at 10 years

Mean bone gain: 1.07 mm (stable 10 years)

Reduced from 6.33 mm to 2.95 mm at 10 years

Reconstructive approach only; stable bone gain, PD improvement, composite success 53%

Long-term reconstructive therapy stable; supportive therapy crucial, defect severity not significant.

All rough (TiUnite); no surface-specific comparison
La Monaca et al. (2018) (21)

0%

PD reduced initially, increased by 5 years (4.62 mm, nonsignificant from baseline)

Initial significant bone gain (1 year), gradual loss by 5 years

4.62 mm at 5 years (from 5.93 mm baseline)

Reconstructive surgery initially effective, unstable outcomes long-term

Initial benefits lost over time, no implants lost; unpredictable outcomes long-term.

All rough (TiUnite); no surface comparison
Leonhardt et al. (2003) (23)

27%

Significant reduction plaque (100%→11%) and bleeding (100%→5%)

Stable in 9 implants, gain in 6 implants, loss in 4 implants

Not explicitly reported; clinical signs significantly improved

Non-reconstructive approach; success 58%, significant clinical improvements

Limited success (58%); smoking negatively impacted outcomes.

All rough surfaces; not directly analyzed
Mercado et al. (2018) (24)

0%

Mean PD from 8.9 mm to 3.5 mm; BOP/suppuration from 100% to 20%

Bone gain (6.92 mm to 2.60 mm mean bone loss at 36 months)

Reduced from 8.9 mm to 3.5 mm at 36 months

Regenerative (reconstructive) approach only, significant PD reduction and bone gain; success 56.7%

Regenerative treatment effective (56.7% success); regular supportive therapy critical.

Not specifically analyzed (micro-rough surfaces)
Noelken et al. (2023) (25)

8.3%

PD significantly reduced (5.05 to 3.08 mm), BOP 100% to 36.4%

Significant bone gain (Interproximal 3.1 mm, Buccal 3.5 mm, Lingual 1.46 mm)

Final PD 3.08 mm

LAPIDER effective for severe defects; significant hard/soft tissue regeneration

LAPIDER provided substantial regeneration and aesthetic improvements.

No direct comparison; rough surfaces only
Roccuzzo et al. (2017) (26)

16.7% overall (SLA:16.7%, TPS:28.6%)

Significant PD reduction, SLA (3.2 mm), TPS (3.4 mm); BOP SLA (7.5%), TPS (30%)

Significant bone fill SLA (2.1 mm gain), TPS (2.0 mm gain)

SLA: 3.2 mm, TPS: 3.4 mm

Regenerative approach better for SLA vs. TPS implants

DBBMC effective; SLA surfaces significantly better clinical outcomes than TPS.
Roccuzzo et al. (2020) (27)

SLA:20%, TPS:45%

Significant PD reduction SLA (3.2 mm), TPS (3.4 mm); BOP significantly reduced

SLA substantial gain (2.7 mm), TPS moderate gain (2.0 mm)

SLA: 3.2 mm, TPS: 3.5 mm

SLA implants superior long-term survival/outcomes

DBBMC stable outcomes; SLA significantly better than TPS long-term
Roccuzzo et al. (2021) (28)

17%

PD 6.89 mm to 4.06 mm; BOP 70.6% to 17.2%

Substantial bone fill; no numeric specifics reported

Reduced from 6.89 mm to 4.06 mm at 5 years

Reconstructive approach only; SLA implants only, survival 80%, success 45.3%, significant PD reduction

Reconstructive protocol effective; adherence to supportive therapy significantly improves outcomes.
Romandini et al. (2024) (16)

19.9%

Not explicitly; high recurrence, retreatment common (24.3%)

Mean additional bone loss: 0.97 mm; >1 mm loss in 42.4%

Not explicitly detailed post-treatment; baseline deepest PD 7.8 mm

Turned surfaces significantly better prognosis; modified surfaces high loss risk (HR = 4.5)

High recurrence; surface type crucial predictor, severe baseline bone loss/suppuration increase loss risk.

Modified surfaces significantly higher implant loss risk (HR = 4.5)
Roos-Jansåker et al. (2011) (29)

0%

Clinical measures not explicitly detailed

Stable bone fill: bone graft (1.3 mm), membrane (1.6 mm), no significant difference

Not explicitly reported

Stable outcomes, no significant membrane advantage

Algipore ± membrane effective, stable bone fill, membrane no additional advantage.

No significant impact reported (mostly machined)
Roos-Jansåker et al. (2014) (30)

0%

PD reduction: 3.0–3.3 mm, BOP significantly reduced

Bone gain stable: 1.1–1.3 mm, no significant membrane advantage

2.6–2.7 mm

No significant advantage with membrane

Stable results; membrane no additional advantage over bone substitute alone.

No significant impact (mostly machined surfaces).
Schwarz et al. (2009) (31)

0% explicitly reported (1 discontinued)

NBM + CM: PD reduction 2.5 mm, NHA: 1.1 mm, BOP significantly reduced

NBM + CM superior bone fill compared to NHA

NBM + CM: 4.6 mm, NHA: 5.8 mm

NBM + CM significantly better than NHA

NBM + CM superior long-term clinical/radiographic outcomes vs. NHA.

Surface-specific outcomes not detailed.

AB, autogenous bone; BDX, bovine-derived xenograft; BOP, bleeding on probing; CAL, clinical attachment level; CHX, chlorhexidine; CI, confidence interval; CM, collagen membrane; CO₂, carbon dioxide; CT, connective tissue; DBBMC, deproteinized bovine bone mineral with collagen; DH, defect height; EMD, enamel matrix derivative; ePTFE, expanded polytetrafluoroethylene; H₂O₂, hydrogen peroxide; HR, hazard ratio; LAPIDER, laser-assisted peri-implant defect regeneration; MBL, marginal bone level; MDBA, mineralized dehydrated bone allograft; NBM, natural bone mineral; NHA, nanocrystalline hydroxyapatite; OR, odds ratio; PD, probing depth; P-IS, peri-implantitis surgery; SLA, sandblasted large grit acid-etched; SOP, suppuration on probing; TPS, titanium plasma-sprayed; β-TCP, beta-tricalcium phosphate.

 Study populations Peri-implantitis

Across the 17 studies analyzed, various diagnostic criteria have been employed to identify peri-implantitis, reflecting differences in study designs and clinical considerations (8–24). The most commonly reported diagnostic parameters include probing depth (PD), bleeding on probing (BOP), suppuration, and radiographic evidence of bone loss.

 Probing depth (PD)

A probing depth threshold of ≥6 mm is frequently used as a criterion to identify peri-implantitis, as observed in studies by Carcuac et al., Romandini et al., and Roccuzzo et al. (15, 16, 26–28). Other studies, such as Aghazadeh et al. and Noelken et al., set a threshold of ≥5 mm, which is similar to the >4 mm threshold considered indicative of disease by Mercado et al. and Schwarz et al. (24, 25, 31, 32). This variation highlights differences at diagnosis across studies.

 Bleeding on probing (BOP) and suppuration

The presence of BOP and/or suppuration was consistently reported as a diagnostic marker in all studies. It serves as an indicator of ongoing inflammation and peri-implant tissue destruction. Studies such as La Monaca et al. and Khoury & Buchmann emphasize the importance of these clinical signs in combination with radiographic findings for accurate diagnosis (20–22).

 Radiographic bone loss

Radiographic evaluation of bone loss is another widely accepted criterion for peri-implantitis diagnosis. The threshold for bone loss varies among studies, with the most commonly reported value being ≥3 mm, as seen in Romandini et al. (16). Other studies, including Carcuac et al. and Aghazadeh et al., defined progressive bone loss based on post-treatment changes or specific defect characteristics, such as angular defects of ≥3 mm (15, 32). A more conservative threshold of ≥1.8 mm was applied in studies such as Roos-Jansåker et al., reflecting the variability in bone loss progression (29, 30).

 Variability in diagnostic criteria

Despite a general agreement on the primary diagnostic signs—probing depth, BOP/suppuration, and radiographic bone loss—variability exists in the specific thresholds and additional criteria applied across studies.

A detailed overview of the case definitions used to include patients with peri-implantitis in each study (treatment group) is provided in Table 2.

Definitions of periimplantitis.

Study Definition of periimplantitis
Aghazadeh et al., 2022 (32) Probing pocket depths of at least 5 mm, presence of bleeding on probing and/or suppuration, radiographic bone loss of 2 mm or more from implant placement to screening, and an angular peri-implant bone defect of 3 mm or greater
Carcuac et al., 2020 (15) Probing pocket depths of 6 mm or more, presence of bleeding on probing, reduced marginal bone level and progressive bone loss greater than 1 mm post-treatment
Deppe et al., 2007 (18) Probing pocket depths of at least 5 mm, presence of bleeding on probing, radiographic evidence of progressive vertical bone loss, and clinical signs of inflammation
Jemt etal., 2021 (19) Bone loss exceeding 0.4 mm, mucosal inflammation, presence of plaque and/or suppuration, and radiographic evidence of marginal bone loss
Khoury et al., 2001 (20) Bone loss of more than 50% of the implant length, augmented probing depths, bleeding on probing, and radiographic evidence of intrabony defects
La Monaca et al., 2018 (21) Progressive bone loss of 3 mm or more detected on radiographs, the presence of bleeding on probing and/or suppuration, and probing depths of at least 5 mm
La Monaca et al., 2024 (22) Progressive angular bone loss of at least 3 mm beyond crestal bone level changes, the presence of bleeding on gentle probing and/or suppuration, and implants in function for more than 12 months
Leonhardt et al., 2003 (23) Marginal bone loss of at least three implant threads compared to baseline radiographs, bleeding on probing and/or suppuration from peri-implant sulci, and microbiological confirmation of peri-implant pathogens
Mercado et al., 2018 (24) Probing pocket depths exceeding 4 mm, the presence of bleeding on probing and/or suppuration, a minimum radiographic bone loss of 20%, and implants that have been in function for at least 2 years
Noelken et al., 2023 (25) Probing pocket depths greater than 5 mm, the presence of bleeding on probing and suppuration, and radiographically confirmed bone loss
Roccuzzo et al., 2017 (26) Probing pocket depths of at least 6 mm, no implant mobility, bleeding on probing and/or suppuration, and radiographic bone loss exceeding three implant threads compared to baseline
Roccuzzo et al., 2020 (27) Probing pocket depths of 6 mm or greater, the presence of bleeding on probing and/or suppuration, radiographic bone loss beyond crestal changes, and the absence of implant mobility
Roccuzzo et al., 2021 (28) Probing pocket depths reach or exceed 6 mm, bleeding on probing, radiographic evidence of progressive bone loss, and the presence of pus or inflammation
Romandini et al., 2024 (16) Probing pocket depths of 6 mm or more, bleeding and/or suppuration on probing, and radiographic evidence of marginal bone loss equal to or greater than 3 mm
Roos-Jansåker et al., 2011 (29) Radiographic bone loss of at least 1.8 mm following the first year in function, the presence of bleeding and/or pus on probing, and inclusion criteria of non-mobile implants
Roos-Jansåker et al., 2014 (30) Radiographic bone loss of at least 3 threads (≥1.8 mm), the presence of a vertical defect component, and bleeding on probing and/or suppuration
Schwarz et al., 2009 (31) Probing pocket depths greater than 4 mm, presence of bleeding on probing and/or suppuration, radiographic evidence of bone loss, and an intrabony defect component of at least 3 mm
Primary outcome: recurrence and treatment failure

The included studies demonstrated that implant surface characteristics influenced recurrence rates following surgical peri-implantitis treatment. Modified (rough) surfaces consistently showed higher recurrence compared with turned (machined) surfaces. Carcuac et al. reported an overall recurrence of 44%, with a significantly increased risk for modified surfaces (OR 5.1) (15). Similarly, Romandini et al. found a retreatment rate of 24.3%. In contrast, studies involving turned surfaces, such as Leonhardt et al., reported more stable outcomes (23). These findings indicate that surface roughness is a key determinant of recurrence and long-term treatment stability. Studies by Schwarz et al., Mercado et al. and Noelken et al. documented relatively stable outcomes without explicitly reporting significant recurrence rates (24, 25, 31).

 Secondary outcomes Implant loss

Implant loss was more frequent among rough surface implants, especially TPS, with Roccuzzo et al. reporting loss in 45% of TPS implants (27), and Leonhardt et al. reporting 27% for turned surfaces (23). SLA surfaces demonstrated better survival than TPS, with 20% vs. 45% loss after 10 years (27). Modified surfaces were identified as a strong predictor of implant loss (HR 4.5) (16). Turned surfaces generally exhibited lower long-term loss risk, around 20%, compared to modified ones (16). Lower implant loss rates were generally associated with reconstructive surgical approaches, as observed by Noelken et al. 8.3% (25) and La Monaca et al. (22), 8.8%.

 Disease resolution and probing depth (PD)

Reconstructive surgery generally improved PD irrespective of surface, but rough surfaces demonstrated greater variability. Mercado et al. (2018) reported PD reduction from 8.9 mm to 3.5 mm on micro-rough implants (24), while Noelken et al. achieved PD reduction from 5.05 mm to 3.08 mm in predominantly rough implants (25) identifying disease resolution. Roccuzzo et al. observed significant PD improvements for SLA implants compared with TPS (26, 27). Turned implants Leonhardt et al., also demonstrated significant PD reduction (23). Conversely, non-reconstructive surgical approaches such as that of Deppe et al. with predominantly rough surfaces showed initial short-term PD reductions with inconsistent long-term stability (18).

 Radiographic bone changes

Bone regeneration outcomes were surface-dependent. Reconstructive procedures around rough implants, particularly SLA, showed consistent bone gain (Roccuzzo et al. + 2.1 mm; + 2.7 mm) (26, 27). TPS implants demonstrated less favorable long-term stability, even with grafting (27). Smooth (turned) surfaces were rarely evaluated in regenerative contexts, limiting conclusions. Khoury & Buchmann reported substantial bone gain (3.2 mm) on rough implants with autografts (20), while Roos-Jansåker et al. found stable bone gain (1.1–1.6 mm) in predominantly machined implants (29, 30).

 Subgroup analyses Turned surfaces

Showed moderate long-term stability, but implant loss remained high when treated non-reconstructively (23). Reconstructive data were limited but suggested stable outcomes (29, 30).

 Modified (rough) surfaces

Non-reconstructive approaches resulted in high recurrence and implant loss (15, 16). Reconstructive approaches improved outcomes, with SLA surfaces outperforming TPS (26, 27).

 Mixed surfaces

Outcomes were heterogeneous. Laser-assisted non-reconstructive therapy demonstrated short-term benefits Deppe et al. (18), but Jemt & Eriksson reported long-term bone loss regardless of surface type (19). Reconstructive treatments showed better results with natural bone mineral combined with a collagen membrane (NBM + CM) compared to nanocrystalline hydroxyapatite (NHA) (31), but surface-specific differences remained underreported. Aghazadeh et al. reported improved outcomes with xenograft (BDX) usage (32).

The detailed study characteristics and outcomes are presented in Tables 1a,b.

 Risk of bias

The risk of bias assessment for the 17 included studies highlights several concerns across different domains (Tables 3a and b).

Risk of bias assessment for RCTs: RoB 2 risk of bias assessment.

Study Bias arising from the randomization process Bias due to deviations from intended interventions Bias due to missing outcome data Bias in measurement of the outcome Bias in selection of the reported result Overall bias
Schwarz 2009 (31) Low Low Some concerns Low Low Some concerns

Risk of bias assessment for non- RCTs: ROBINS-i risk of bias assessment.

Study Bias due to confounding Bias in selection of participants into the study Bias in classification of interventions Bias due to deviations from intended interventions Bias due to missing data Bias in measurement of outcomes Bias in selection of reported results Overall bias
Aghazadeh 2022 (32) Moderate Serious Low Moderate Serious Moderate Low Serious
Carcuac 2020 (15) Moderate Serious Low Moderate High Low Low Serious
Deppe 2007 (18) Moderate Moderate Low Moderate Serious Moderate Low Serious
Jemt et al. 2021 (19) Moderate Serious Low Moderate Serious Moderate Low Serious
Khoury 2001 (20) Serious Low Moderate Moderate Low Moderate Low Moderate
La Monaca 2018 (21) Moderate Moderate Low Moderate Serious Low Low Moderate
La Monaca 2024 (22) Serious Serious Low Moderate Serious Moderate Low Serious
Leonhardt 2003 (23) Moderate Low Low Moderate Low Moderate Low Moderate
Mercado 2018 (24) Moderate Low Low Moderate Low Low Low Moderate
Noelken 2023 (25) Moderate Moderate Low Moderate Serious Moderate Low Moderate
Roccuzzo 2017 (26) Moderate Moderate Low Moderate Moderate Low Low Moderate
Roccuzzo 2020 (27) Moderate Serious Low Moderate Serious Low Low Serious
Roccuzzo 2021 (28) Moderate Serious Low Moderate Serious Moderate Low Serious
Romandini 2024 (16) Moderate Serious Low Moderate Serious Moderate Low Serious
Roos-Jansaker 2011 (29) Moderate Serious Low Moderate Serious Low Low Serious
Roos-Jansaker 2014 (30) Moderate Serious Low Moderate Serious Low Low Serious

The RCT (Schwarz 2009) had some concerns (31).

Among the non-randomized studies, serious risk of bias was frequently noted in selection of participants e.g., Aghazadeh, Carcuac, and La Monaca (15, 17, 22) and missing data e.g., Roccuzzo, Romandini, Roos-Jansaker (16, 27, 30). However, intervention classification and reporting of results were generally at low risk across studies. Confounding and deviations from interventions were rated as moderate risk in most cases.

Ten studies were judged to have a serious overall bias, primarily due to participant selection and missing data. The remaining studies had a moderate overall bias, with issues mainly related to confounding and missing data.

Certainty of evidence for the main outcomes was assessed using the GRADE approach and is presented in Supplementary Table S1. Overall, the certainty was judged to be very low to low across all outcomes, primarily due to serious risk of bias, high heterogeneity of diagnostic criteria and outcome definitions, small sample sizes, and imprecision of effect estimates.

 Discussion

This systematic review aimed to evaluate the impact of implant surface characteristics on the long-term outcomes of surgical treatment of peri-implantitis. The main findings indicate that modified (rough) surfaces are consistently associated with higher recurrence and implant loss compared with turned (machined) surfaces. Within rough surfaces, SLA implants achieved more favorable outcomes than TPS, particularly in reconstructive contexts (15, 16, 26–28). In contrast, smooth implants demonstrated comparatively lower recurrence (23). These results underscore that implant surface topography can be a determinant of surgical treatment prognosis.

The effectiveness of peri-implantitis surgery is influenced by both treatment modality and implant surface. For non-regenerative procedures, modified surfaces were repeatedly associated with worse outcomes: Carcuac et al. reported a 44% recurrence rate with rough implants (15), while Romandini et al. identified modified surfaces such as TiUnite and SLA as predictors of implant loss (16). In contrast, turned surfaces showed more stable disease suppression (23).

For regenerative approaches, implant surface also played a key role. SLA implants demonstrated favorable long-term bone gain and PD reduction (26–28), whereas TPS implants performed poorly even when grafting was applied (27). Although smooth implants were less frequently studied in regenerative contexts, available evidence suggests they may perform adequately when combined with supportive therapy (29, 30).

Bone regeneration outcomes differed substantially according to surface characteristics. Greater bone fill was generally reported around rough surfaces when grafting materials were used. Khoury and Buchmann observed a 2.4 mm gain at 12 months using autogenous grafts on rough implants (20). Roccuzzo et al. reported significant defect reduction with xenografts, particularly in SLA implants, while TPS implants showed limited stability (26, 27). Comparable results with alloplastic materials were also noted (33, 34). However, bone regeneration around smooth surfaces was less favorable: Roos-Jansåker et al. reported limited improvement with alloplastic grafts (30). Thus, while rough implants may predispose to recurrence, they also appear to support more pronounced bone regeneration after reconstructive procedures.

This paradox may be explained by surface-related biology. Rough surfaces are harder to decontaminate and accumulate more plaque (35, 36), yet they may stabilize the coagulum and promote defect fill (37). Accordingly, radiographic bone gain does not necessarily correspond to re-osseointegration, as several animal studies identified connective tissue interposition rather than true reattachment (38–40).

The role of membranes in guided bone regeneration (GBR) has also been linked to implant surfaces. Khoury et al. showed greater bone gain with non-resorbable membranes around rough implants (20), while Deppe et al. observed comparable results with resorbable membranes (18). These data suggest that both membrane type and surface roughness influence regenerative outcomes. Furthermore, clinical studies and experimental models in dogs indicate that rough surfaces generally achieve greater defect fill than smooth surfaces under GBR conditions (37).

Surface characteristics may also impact soft tissue attachment. Excessively smooth surfaces can impair mucosal adhesion, as Quirynen et al. observed attachment loss on polished abutments compared with stable CAL around commercially available surfaces (41). Other studies support that maintaining a certain degree of roughness enhances soft tissue sealing (42). These findings provide a biological explanation for the improved clinical outcomes of rough implants after GBR, despite their higher susceptibility to recurrence.

Interpretation of the evidence is complicated by considerable heterogeneity. Defect morphology influences outcomes, with narrower defects showing better results (17, 43), yet most studies failed to provide detailed descriptions, limiting cross-study comparisons. Moreover, peri-implantitis definitions varied widely: Roccuzzo et al. required ≥6 mm PD and bone loss exceeding three implant threads (26), while Mercado et al. used ≥4 mm PD and ≥20% radiographic bone loss (24). Measurement variability further complicates interpretation (44). Such inconsistencies directly affect assessment of surface-related outcomes and hinder robust comparisons across studies.

This review is limited by the substantial heterogeneity among the included studies, particularly in peri-implantitis diagnostic criteria, defect morphology, surgical techniques, and outcome measures. Most studies were small in size, lacked standardized definitions, and many were judged to have a serious overall risk of bias, especially in participant selection and missing data. Confounding variables were insufficiently controlled, further reducing certainty. Furthermore, the restriction to English-language studies may have introduced language bias, potentially leading to omission of relevant non-English publications. Applying the GRADE framework, the certainty of the available evidence was rated as very low to low for all main outcomes, reflecting methodological shortcomings and heterogeneity among the included studies. These limitations restrict the generalizability of the findings and reinforce the need for well-designed, adequately powered randomized controlled trials with standardized definitions and longer follow-up.

 Conclusion

The effectiveness of peri-implantitis surgery is influenced by implant surface characteristics and treatment modality. Modified surfaces are generally more prone to recurrence and implant loss, with SLA implants performing better than TPS, while turned surfaces appear less susceptible but remain insufficiently studied in regenerative contexts. Reconstructive approaches combined with supportive care consistently provide the most favorable outcomes. Given the very low to low certainty of the evidence with heterogenous results, current findings should be interpreted with caution, and well-designed long-term randomized trials with standardized definitions and consistent surface classifications are urgently needed. Future trials should adopt standardized outcome definitions (e.g., PD thresholds, BOP, radiographic bone loss criteria) to allow comparability across studies. Research should focus on RCTs directly comparing surface types, long-term follow-up, and adjustment for confounding factors such as defect morphology and maintenance compliance. Addressing these gaps will clarify the role of implant surface modifications.

Clinical implications

When planning peri-implantitis surgery, implant surface characteristics should be taken into account, but they must not be considered in isolation. Evidence indicates that reconstructive approaches yield more reliable outcomes than non-reconstructive ones, particularly for rough implants, with SLA surfaces performing more favorably than TPS. Turned (machined) surfaces appear less prone to recurrence, although data on regenerative protocols remain scarce. These observations suggest that implant surface may influence prognosis, yet it represents only one part of a complex clinical picture.

Patient-related risk factors (such as smoking, systemic conditions, low compliance and/or adherence to supportive care) exert a profound effect on long-term success and may outweigh surface-related differences. Surgical decision-making should therefore be individualized, integrating implant surface type, defect morphology, patient risk profile, and anticipated compliance. The use of biomaterials and barrier membranes may enhance regenerative outcomes around rough implants, but clinicians should be cautious, as radiographic bone gain does not necessarily reflect true re-osseointegration, and complete defect resolution is rarely achievable.

Nevertheless, these clinical implications must be interpreted with caution. The available evidence is heterogeneous, often based on small studies with differing peri-implantitis definitions, inconsistent outcome measures, and a serious overall risk of bias. The evidence was rated as very low to low for all main outcomes. This means that while current data can guide clinical choices, they cannot provide definitive recommendations.

 Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

 Author contributions

PG: Conceptualization, Formal analysis, Methodology, Data curation, Writing – original draft, Writing – review & editing, Investigation. CG: Formal analysis, Methodology, Data curation, Writing – review & editing. AS: Conceptualization, Formal analysis, Methodology, Data curation, Investigation, Writing – review & editing, Project administration. AZ: Supervision, Conceptualization, Methodology, Formal analysis, Data curation, Investigation, Writing – original draft, Writing – review & editing.

 Funding

The author(s) declare that no financial support was received for the research and/or publication of this article.

 Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

 Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issue please contact us.

 Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fdmed.2025.1661369/full#supplementary-material

 References AlbrektssonTWennerbergA. On osseointegration in relation to implant surfaces. Clin Implant Dent Relat Res. (2019) 21(Suppl 1):4–7. 10.1111/cid.1274230816639 RuppFLiangLGeis-GerstorferJScheidelerLHüttigF. Surface characteristics of dental implants: a review. Dent Mater. (2018) 34(1):40–57. 10.1016/j.dental.2017.09.00729029850 ShayebMAElfadilSAbutayyemHShqaidefAMarrapodiMMCicciùM Bioactive surface modifications on dental implants: a systematic review and meta-analysis of osseointegration and longevity. Clin Oral Investig. (2024) 28(11):592. 10.1007/s00784-024-05958-y39392473 SouzaJCMSordiMBKanazawaMRavindranSHenriquesBSilvaFS Nano-scale modification of titanium implant surfaces to enhance osseointegration. Acta Biomater. (2019) 94:112–31. 10.1016/j.actbio.2019.05.04531128320 MatosGRM. Surface roughness of dental implant and osseointegration. J Maxillofac Oral Surg. (2021) 20(1):1–4. 10.1007/s12663-020-01437-533584035 Romero-SerranoMRomero-RuizMMHerrero-ClimentMRios-CarrascoBGil-MurJ. Correlation between implant surface roughness and implant stability: a systematic review. Dent J (Basel). (2024) 12(9):276. 10.3390/dj1209027639329842 KupkaJRKönigJAl-NawasBSaghebKSchiegnitzE. How far can we go? A 20-year meta-analysis of dental implant survival rates. Clin Oral Investig. (2024) 28(10):541. 10.1007/s00784-024-05929-339305362 RenvertSPerssonGRPirihFQCamargoPM. Peri-implant health, peri-implant mucositis, and peri-implantitis: case definitions and diagnostic considerations. J Periodontol. (2018) 89(Suppl 1):S304–s12. 10.1002/JPER.17-058829926953 DiazPGonzaloEVillagraLJGMiegimolleBSuarezMJ. What is the prevalence of peri-implantitis? A systematic review and meta-analysis. BMC Oral Health. (2022) 22(1):449. 10.1186/s12903-022-02493-836261829 HusseinAShahMAtiehMAAlhimairiSAmir-RadFElbishariH. Influence of implant surfaces on peri-implant diseases – A systematic review and meta-analysis. Int Dent J. (2025) 75(1):75–85. 10.1016/j.identj.2024.10.00739532569 StavropoulosABertlKWinningLPolyzoisI. What is the influence of implant surface characteristics and/or implant material on the incidence and progression of peri-implantitis? A systematic literature review. Clin Oral Implants Res. (2021) 32(Suppl 21):203–29. 10.1111/clr.1385934642989 Garaicoa-PazminoCLinGHAlkanderyAParra-CarrasquerCSuárez-López Del AmoF. Influence of implant surface characteristics on the initiation, progression and treatment outcomes of peri-implantitis: a systematic review and meta-analysis based on animal model studies. Int J Oral Implantol (Berl. (2021) 14(4):367–82.34726847 VernonJJRaïfEMAwJAttenboroughEJhaADoT. Dental implant surfaces and their interaction with the oral microbiome. Dentistry Review. (2022) 2(4):100060. 10.1016/j.dentre.2022.100060 WassmannTKreisSBehrMBuergersR. The influence of surface texture and wettability on initial bacterial adhesion on titanium and zirconium oxide dental implants. Int J Implant Dent. (2017) 3(1):32. 10.1186/s40729-017-0093-328714053 CarcuacODerksJAbrahamssonIWennströmJLBerglundhT. Risk for recurrence of disease following surgical therapy of peri-implantitis-A prospective longitudinal study. Clin Oral Implants Res. (2020) 31(11):1072–7. 10.1111/clr.1365332870513 RomandiniMBougasKAlibegovicLHosseiniSCarcuacOBerglundhT Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis - A retrospective study. Clin Oral Implants Res. (2024) 35(3):321–9. 10.1111/clr.1422838112108 AghazadehAPerssonGRRenvertS. Impact of bone defect morphology on the outcome of reconstructive treatment of peri-implantitis. Int J Implant Dent. (2020) 6. 10.1186/s40729-020-00219-532548733 DeppeHHorchHHNeffA. Conventional versus CO2 laser-assisted treatment of peri-implant defects with the concomitant use of pure-phase beta-tricalcium phosphate: a 5-year clinical report. Int J Oral Maxillofac Implants. (2007) 22(1):79–86.17340900 JemtTErikssonJ. Bone loss before and after peri-implantitis surgery: a 7-year retrospective observational study. Int J Oral Maxillofac Implants. (2021) 36(6):1199–210. 10.11607/jomi.917534919622 KhouryFBuchmannR. Surgical therapy of peri-implant disease: a 3-year follow-up study of cases treated with 3 different techniques of bone regeneration. J Periodontol. (2001) 72(11):1498–508. 10.1902/jop.2001.72.11.149811759861 La MonacaGPrannoNAnnibaliSCristalliMPPolimeniA. Clinical and radiographic outcomes of a surgical reconstructive approach in the treatment of peri-implantitis lesions: a 5-year prospective case series. Clin Oral Implants Res. (2018) 29(10):1025–37. 10.1111/clr.1336930267445 La MonacaGPrannoNAnnibaliSPolimeniACristalliMP. A 10-year follow-up of reconstructive treatment of peri-implantitis using mineralized dehydrated allograft and resorbable membrane: a retrospective case series. Clin Oral Implants Res. (2024) 36:325–38. 10.1111/clr.1438539611397 LeonhardtADahlénGRenvertS. Five-year clinical, microbiological, and radiological outcome following treatment of peri-implantitis in man. J Periodontol. (2003) 74(10):1415–22. 10.1902/jop.2003.74.10.141514653386 MercadoFHamletSIvanovskiS. Regenerative surgical therapy for peri-implantitis using deproteinized bovine bone mineral with 10% collagen, enamel matrix derivative and doxycycline-A prospective 3-year cohort study. Clin Oral Implants Res. (2018) 29(6):583–91. 10.1111/clr.1325629767434 NoelkenRWestphalLSchiegnitzEAl-NawasB. Hard and soft tissue regeneration of severe peri-implantitis defects with the laser-assisted peri-implant defect regeneration technique: 3-year results. Int J Implant Dent. (2023) 9(1):3. 10.1186/s40729-023-00467-136739596 RoccuzzoMPittoniDRoccuzzoACharrierLDalmassoP. Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized bovine bone mineral with 10% collagen: 7-year-results. Clin Oral Implants Res. (2017) 28(12):1577–83. 10.1111/clr.1302828626970 RoccuzzoMFierravantiLPittoniDDalmassoPRoccuzzoA. Implant survival after surgical treatment of peri-implantitis lesions by means of deproteinized bovine bone mineral with 10% collagen: 10-year results from a prospective study. Clin Oral Implants Res. (2020) 31(8):768–76. 10.1111/clr.1362832559322 RoccuzzoMMirraDPittoniDRamieriGRoccuzzoA. Reconstructive treatment of peri-implantitis infrabony defects of various configurations: 5-year survival and success. Clin Oral Implants Res. (2021) 32(10):1209–17. 10.1111/clr.1381834352140 Roos-JansåkerAMLindahlCPerssonGRRenvertS. Long-term stability of surgical bone regenerative procedures of peri-implantitis lesions in a prospective case-control study over 3 years. J Clin Periodontol. (2011) 38(6):590–7. 10.1111/j.1600-051X.2011.01729.x Roos-JansåkerAMPerssonGRLindahlCRenvertS. Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane: a 5-year follow-up. J Clin Periodontol. (2014) 41(11):1108–14. 10.1111/jcpe.12308 SchwarzFSahmNBielingKBeckerJ. Surgical regenerative treatment of peri-implantitis lesions using a nanocrystalline hydroxyapatite or a natural bone mineral in combination with a collagen membrane: a four-year clinical follow-up report. J Clin Periodontol. (2009) 36(9):807–14. 10.1111/j.1600-051X.2009.01443.x19637997 AghazadehAPerssonGRStavropoulosARenvertS. Reconstructive treatment of peri-implant defects-results after three and five years. Clin Oral Implants Res. (2022) 33(11):1114–24. 10.1111/clr.1399436062917 WohlfahrtJCLyngstadaasSPRønoldHJSaxegaardEEllingsenJEKarlssonS Porous titanium granules in the surgical treatment of peri-implant osseous defects: a randomized clinical trial. Int J Oral Maxillofac Implants. (2012) 27(2):401–10.22442781 RoccuzzoMBoninoFBoninoLDalmassoP. Surgical therapy of peri-implantitis lesions by means of a bovine-derived xenograft: comparative results of a prospective study on two different implant surfaces. J Clin Periodontol. (2011) 38(8):738–45. 10.1111/j.1600-051X.2011.01742.x21635278 SubramaniKJungREMolenbergAHammerleCH. Biofilm on dental implants: a review of the literature. Int J Oral Maxillofac Implants. (2009) 24(4):616–26.19885401 SaulacicNSchallerB. Prevalence of peri-implantitis in implants with turned and rough surfaces: a systematic review. J Oral Maxillofac Res. (2019) 10(1):e1. 10.5037/jomr.2019.1010131069039 PerssonLGBerglundhTLindheJSennerbyL. Re-osseointegration after treatment of peri-implantitis at different implant surfaces. An experimental study in the dog. Clin Oral Implants Res. (2001) 12(6):595–603. 10.1034/j.1600-0501.2001.120607.x11737103 PerssonLGAraújoMGBerglundhTGröndahlKLindheJ. Resolution of peri-implantitis following treatment. An experimental study in the dog. Clin Oral Implants Res. (1999) 10(3):195–203. 10.1034/j.1600-0501.1999.100302.x10522179 SchwarzFJepsenSHertenMSagerMRothamelDBeckerJ. Influence of different treatment approaches on non-submerged and submerged healing of ligature induced peri-implantitis lesions: an experimental study in dogs. J Clin Periodontol. (2006) 33(8):584–95. 10.1111/j.1600-051X.2006.00956.x16899102 YouTMChoiBHZhuSJJungJHLeeSHHuhJY Treatment of experimental peri-implantitis using autogenous bone grafts and platelet-enriched fibrin glue in dogs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. (2007) 103(1):34–7. 10.1016/j.tripleo.2006.01.00517178491 QuirynenMBollenCMPapaioannouWVan EldereJvan SteenbergheD. The influence of titanium abutment surface roughness on plaque accumulation and gingivitis: short-term observations. Int J Oral Maxillofac Implants. (1996) 11(2):169–78.8666447 DorkhanMYücel-LindbergTHallJSvensäterGDaviesJR. Adherence of human oral keratinocytes and gingival fibroblasts to nano-structured titanium surfaces. BMC Oral Health. (2014) 14(75). 10.1186/1472-6831-14-7524952379 PolyzoisIRenvertSBosshardtDDLangNPClaffeyN. Effect of bio-Oss on osseointegration of dental implants surrounded by circumferential bone defects of different dimensions: an experimental study in the dog. Clin Oral Implants Res. (2007) 18(3):304–10. 10.1111/j.1600-0501.2007.01207.x17298496 KoldslandOCScheieAAAassAM. Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss. J Periodontol. (2010) 81(2):231–8. 10.1902/jop.2009.09026920151801 AfrashtehfarKIAlfallajHAFernandezEHussainiS. Guided bone regeneration improves defect fill and reconstructive outcomes in 3-wall peri-implantitis defects. Evid Based Dent. (2024) 26:29–31. 10.1038/s41432-024-01073-939397174 AstolfiVGómez-MencheroARíos-SantosJVBullónPGaleoteFRíos-CarrascoB Influence of removing or leaving the prosthesis after regenerative surgery in peri-implant defects: retrospective study: 32 clinical cases with 2 to 8 years of follow-up. Int J Environ Res Public Health. (2021) 18(2):645. 10.3390/ijerph1802064533451161 BehnekeABehnekeNd'HoedtB. Treatment of peri-implantitis defects with autogenous bone grafts: six-month to 3-year results of a prospective study in 17 patients. Int J Oral Maxillofac Implants. (2000) 15(1):125–38.10697947 BerglundhTWennströmJLLindheJ. Long-term outcome of surgical treatment of peri-implantitis. A 2-11-year retrospective study. Clin Oral Implants Res. (2018) 29(4):404–10. 10.1111/clr.1313829575025 BianchiniMAGalarraga-VinuezaMEBedoyaKACorreaBBde Souza MaginiRSchwarzF. Implantoplasty enhancing peri-implant bone stability over a 3-year follow-up: a case series. Int J Periodontics Restorative Dent. (2020) 40(1):e1–8. 10.11607/prd.384931815972 BianchiniMAKuhlkampLFSchwarzFGalarraga-VinuezaME. Clinical and radiographic outcomes of resective surgery with adjunctive implantoplasty over a 6- to 11-year follow-up: a case series. Int J Periodontics Restorative Dent. (2024) 44(4):466–76. 10.11607/prd.675637655972 CarcuacODerksJCharalampakisGAbrahamssonIWennströmJBerglundhT. Adjunctive systemic and local antimicrobial therapy in the surgical treatment of peri-implantitis: a randomized controlled clinical trial. J Dent Res. (2016) 95(1):50–7. 10.1177/002203451560196126285807 ChiangYCSirinirundBRodriguezAVelasquezDChanHL. Operating microscope-assisted reconstructive strategy for peri-implantitis: a case series report. Clin Adv Periodontics. (2024) 14(3):149–56. 10.1002/cap.1026537724638 CortelliniPCortelliniSBonacciniDTonettiMS. Papilla preservation and minimally invasive surgery for the treatment of peri-implant osseous defects. Clinical and radiographic outcomes of a 5-year retrospective study. Clin Oral Implants Res. (2021) 32(11):1384–96. 10.1111/clr.1382634358358 FroumSJFroumSHRosenPS. Successful management of peri-implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3- to 7.5-year follow-up. Int J Periodontics Restorative Dent. (2012) 32(1):11–20.22254219 FroumSJFroumSHRosenPS. A regenerative approach to the successful treatment of peri-implantitis: a consecutive series of 170 implants in 100 patients with 2- to 10-year follow-up. Int J Periodontics Restorative Dent. (2015) 35(6):857–63. 10.11607/prd.257126509990 KhayatPAidanDCalatravaJWangHL. Bone regeneration following implantoplasty: a retrospective cohort study with long-term radiographic assessment. Int J Periodontics Restorative Dent. (2024) 0(0):1–17. 10.11607/prd.742239705511 LombardoGMarincolaMCicconettiASimancas-PallaresMAPighiJLehrbergJ Successful management of peri-implantitis around short and ultrashort single-crown implants: a case series with a 3-year follow-up. Int J Dent. (2019) 2019:5302752. 10.1155/2019/530275231636671 MonjeASchwarzF. Principles of combined surgical therapy for the management of peri-implantitis. Clin Adv Periodontics. (2022) 12(1):57–63. 10.1002/cap.1018634569711 Parma-BenfenatiSTintiCRomanoFRoncatiMAimettiM. Long-Term outcome of surgical regenerative treatment of peri-implantitis: a 2- to 21-year retrospective evaluation. Int J Periodontics Restorative Dent. (2020) 40(4):487–96. 10.11607/prd.464732559030 RenvertSPolyzoisIClaffeyN. Surgical therapy for the control of peri-implantitis. Clin Oral Implants Res. (2012) 23(Suppl 6):84–94. 10.1111/j.1600-0501.2012.02554.x23062132 RenvertSGiovannoliJ-LRinkeS. The efficacy of reconstructive therapy in the surgical management of peri-implantitis: a 3-year follow-up of a randomized clinical trial. J Clin Periodontol. (2024) 51(10):1267–76. 10.1111/jcpe.1404939020503 SarmientoHLNortonMKorostoffJKoKIFiorelliniJP. Surgical alternatives for treating peri-implantitis. Int J Periodontics Restorative Dent. (2018) 38(5):665–71. 10.11607/prd.363930113606 SchwarzFJohnGBeckerJ. Reentry after combined surgical resective and regenerative therapy of advanced peri-implantitis: a retrospective analysis of five cases. Int J Periodontics Restorative Dent. (2015) 35:647–53. 10.11607/prd.232026357694 SchwarzFSahmNBeckerJ. Combined surgical therapy of advanced peri-implantitis lesions with concomitant soft tissue volume augmentation. A case series. Clin Oral Implants Res. (2014) 25(1):132–6. 10.1111/clr.1210323350647 SchwarzFHegewaldAJohnGSahmNBeckerJ. Four-year follow-up of combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination. J Clin Periodontol. (2013) 40(10):962–7. 10.1111/jcpe.1214323931259 SchwarzFJohnGSchmuckerASahmNBeckerJ. Combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination: a 7-year follow-up observation. J Clin Periodontol. (2017) 44(3):337–42. 10.1111/jcpe.1264828101947 WangCWAshnagarSGianfilippoRDArnettMKinneyJWangHL. Laser-assisted regenerative surgical therapy for peri-implantitis: a randomized controlled clinical trial. J Periodontol. (2021) 92(3):378–88. 10.1002/JPER.20-004032761810 Appendix

Excluded studies.

Authors and date Study title Reason for exclusion
Afrashtehfar et al. 2024 (45) Guided bone regeneration improves defect fill and reconstructive outcomes in 3-wall peri-implantitis defects Implant type not taken into consideration
Astolfi et al. 2021 (46) Influence of removing or leaving the prosthesis after regenerative surgery in peri-implant defects: retrospective study: 32 clinical cases with 2–8 years of follow-up Outcomes reported not correlated to implant type
Behneke et al. 2000 (47) Treatment of peri-implantitis defects with autogenous bone grafts: six-month to 3-year results of a prospective study in 17 patients Implant type not taken into consideration
Berglundh 2018 (48) Long- term outcome of surgical treatment of periimplantitis. A2–11-year retrospective study Minimum study duration less than 3 years
Bianchini et al. 2020 (49) Implantoplasty enhancing peri-implant bone stability over a 3-year follow-up: a case series Implant type not taken into consideration
Bianchini et al. (2024) (50) Clinical and radiographic outcomes of resective surgery with adjunctive implantoplasty over a 6- to 11-year follow-up: a case series Implants treated with implantoplasty, which creates a modified surface texture differing from the original implant surface
Carcuac et al. 2016 (51) Adjunctive systemic and local antimicrobial therapy in the surgical treatment of peri-implantitis: a randomized controlled clinical trial Study duration less than 3 years
Chiang et al. 2024 (52) Operating microscope-assisted reconstructive strategy for peri-implantitis: A case series report Implant type not taken into consideration
Cortellini et al. 2021 (53) Papilla preservation and minimally invasive surgery for the treatment of peri-implant osseous defects. Clinical and radiographic outcomes of a 5-year retrospective study Implant type not taken into consideration
Froum et al. 2012 (54) Successful management of peri-implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3- to 7.5-year follow-up Outcomes mentioned not correlated to implant surfaces
Froum et al. 2015 (55) A regenerative approach to the successful treatment of peri-implantitis: a consecutive series of 170 implants in 100 patients with 2- to 10-year follow-up Implant type not taken into consideration
Khayat et al. 2024 (56) Bone regeneration following implantoplasty: a retrospective cohort study with long-term radiographic assessment Implant type not taken into consideration
Lombardo et al. 2019 (57) Successful management of peri-implantitis around short and ultrashort single-crown implants: a case series with a 3-year follow-up Implant type not taken into consideration
Monje et al. 2022 (58) Principles of combined surgical therapy for the management of peri-implantitis Incorrect study design
Parma-Benfenati et al. 2020 (59) Long-term outcome of surgical regenerative treatment of peri-implantitis: a 2- to 21-year retrospective evaluation Study duration less than 3 years (varied for 2–21 years)
Renvert et al. 2012 (60) Surgical therapy for the control of peri-implantitis Incorrect study design
Renvert et al. 2024 (61) The efficacy of reconstructive therapy in the surgical management of peri-implantitis: A 3-year follow-up of a randomized clinical trial Implant type not taken into consideration
Sarmiento et al. 2018 (62) Surgical alternatives for treating peri-implantitis Implant type not taken into consideration
Schwarz et al. 2015 (63) Reentry after combined surgical resective and regenerative therapy of advanced peri-implantitis: a retrospective analysis of five cases Implant type not taken into consideration
Schwarz et al. 2014 (64) Combined surgical therapy of advanced peri-implantitis lesions with concomitant soft tissue volume augmentation. A case series Study duration less than 3 years
Schwarz et al. 2013 (65) Four-year follow-up of combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination Implants treated with implantoplasty, which creates a modified surface texture differing from the original implant surface
Schwarz et al. 2017 (66) Combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination: a 7-year follow-up observation Implants treated with implantoplasty, which creates a modified surface texture differing from the original implant surface
Wang et al. 2021 (67) Laser-assisted regenerative surgical therapy for peri-implantitis: A randomized controlled clinical trial Study duration less than 3 years

Full search strategies.

Database Search Strategy
PubMed (MEDLINE via PubMed) (Periimplantitis OR peri-implantitis OR peri implantitis OR periimplant OR peri-implant OR peri implant)AND(treatment outcome OR therapy OR surgical treatment OR regenerative OR regeneration OR tissue regeneration OR reconstructive surgery OR bone graft OR bone substitute OR membranes OR surgical flap OR open flap debridement OR resective OR implantoplasty OR surface decontamination)AND(surface characteristics OR surface roughness OR material characteristics OR titanium surface OR implant types OR implant surfaces OR surface topography OR surface analysis)AND(implant survival OR bone loss OR recurrence OR retreatment OR radiographic stability OR long-term OR 3 years OR follow-up)
Embase (‘periimplantitis’/exp OR periimplantitis OR ‘peri-implantitis’ OR ‘peri implantitis’ OR periimplant OR ‘peri-implant’ OR ‘peri implant’)AND(‘treatment outcome'/exp OR therapy OR ’surgical treatment'/exp OR ‘regenerative therapy'/exp OR regeneration OR ‘tissue regeneration’ OR ‘reconstructive surgery'/exp OR ‘bone graft'/exp OR ‘bone substitute'/exp OR membranes OR ‘surgical flap’ OR ‘open flap debridement’ OR resective OR implantoplasty OR ‘surface decontamination’)AND(‘surface property'/exp OR ‘surface roughness'/exp OR ‘material property'/exp OR ‘titanium surface’ OR ‘implant type'/exp OR ‘implant surface'/exp OR ‘surface topography'/exp OR ‘surface analysis’)AND(‘dental implant survival'/exp OR ‘bone loss'/exp OR recurrence OR retreatment OR ‘radiographic stability’ OR ‘long term’ OR ‘3 years’ OR ‘follow-up’)
Cochrane library (periimplantitis OR “peri-implantitis” OR “peri implantitis” OR periimplant OR “peri-implant” OR “peri implant”)AND(“treatment outcome” OR therapy OR “surgical treatment” OR regenerative OR regeneration OR “tissue regeneration” OR “reconstructive surgery” OR “bone graft” OR “bone substitute” OR membranes OR “surgical flap” OR “open flap debridement” OR resective OR implantoplasty OR “surface decontamination”)AND(“surface characteristics” OR “surface roughness” OR “material characteristics” OR “titanium surface” OR “implant types” OR “implant surfaces” OR “surface topography” OR “surface analysis”)AND(“implant survival” OR “bone loss” OR recurrence OR retreatment OR “radiographic stability” OR “long term” OR “3 years” OR “follow-up”)