Surface engineering facing the challenge of peri-implant diseases

While dental implantology shows high survival rates, clinical longevity remains threatened by mucositis and peri-implantitis. These biological complications not only alter implant stability but also significantly impact patients' quality of life. At the heart of this issue lies the surface condition of the titanium, which must strike a complex balance: promoting robust osseointegration while drastically limiting early microbial colonization.

The objective of this narrative review is to evaluate contemporary surface modification strategies published between 2020 and 2025 (indexed on PubMed, Scopus, and Web of Science). The authors analyse the influence of topography, roughness, chemistry, and wettability on the biological response at the interface, specifically examining bioactive ceramic coatings, ion and nanoparticle incorporation, anodisation, as well as laser treatments.

The study is based on the hypothesis that no current surface modification yet simultaneously optimizes osteogenesis and bacterial resistance. The authors test the idea that the emergence of nanostructured multifunctional approaches could bridge this therapeutic gap and improve long-term clinical performance, beyond current industry standards.

Narrative review methodology

This study is a narrative review that synthesizes scientific data published over a five-year period, between 2020 and 2025. The literature search was structured around three major databases: PubMed, Scopus, and Web of Science.

The analysis protocol is based on a critical evaluation of surface characteristics influencing the biological interface of the implant. The authors examined the following variables:

• Topography and surface roughness.
• Surface chemistry and the degree of wettability (hydrophilicity).

Contemporary modification strategies have been classified and analyzed according to five main technological groups: anodization, laser surface treatments, the creation of nanotopographies, the incorporation of ions or nanoparticles, and the application of bioactive ceramic coatings.

The study evaluates these technologies not only for their efficacy on osteoblastic responses, but also for their impact on initial microbial colonization. The methodological analysis integrates advances in multifunctional approaches seeking to couple osteogenic and antibacterial properties, while highlighting the limitations of current evidence regarding long-term performance.

Analysis of surface parameters and engineering strategies

This narrative review synthesized data from the literature published between 2020 and 2025 (PubMed, Scopus, and Web of Science sources). The analysis focuses on the impact of topography, roughness, chemistry, and wettability of implant surfaces on biological responses at the bone-implant interface.

The authors report that contemporary surface modifications aim for a balance between osseointegration and biofilm resistance. The results highlight several categories of surface treatments and their respective effects:

Qualitative observations and multifunctional approaches

The synthesis of data indicates a transition towards multifunctional approaches. Rather than focusing solely on roughness to promote osseointegration, new strategies seek to combine osteogenic and antimicrobial properties within the same interface.

• Nanostructured surfaces: Data suggest a high potential for modulating the epigenetic response and improving long-term performance.
• Laser modification: This technology is identified as a promising avenue for debridement and improvement of biocompatibility during the treatment of peri-implantitis.
• Wettability: The study highlights that surface contaminants and the hydrocarbon film significantly influence wettability measurements, indirectly impacting the initial biological response.

The authors conclude that no single surface modification currently succeeds in simultaneously and fully optimizing osseointegration and bacterial resistance. However, laser-modified surfaces and nanostructures show the most encouraging results for implant longevity.

Analysis of surface strategies 2020-2025

This narrative review highlights a paradigm shift: clinical performance no longer depends solely on macroscopic roughness, but on precise nanometric modulation of the interface. The compiled data indicate that nanostructured surfaces and laser treatments represent the most serious avenues for improving clinical outcomes, surpassing purely chemical or conventional topographical approaches.

The authors point out, however, a fundamental limitation: the absence of a universal "ideal" surface. Although multifunctional approaches combining osteogenic and antimicrobial properties are booming, their long-term validation still lacks sufficient statistical hindsight. This synthesis shows that current innovations (nanoparticles, anodization) offer promising perspectives, but their absolute superiority in a real clinical environment remains to be confirmed compared to reference surfaces.

For the practitioner, these results confirm that the choice of implant must now integrate surface engineering as a direct lever for the long-term success of the treatment. The evolution towards laser-modified surfaces could reduce biological complications, although vigilance remains necessary regarding the implementation of new technologies lacking ten-year evidence. The personalization of the clinical approach, mentioned by the review, therefore becomes a major decision criterion in the dental practice.

Summary of results

The authors of this review, analyzing data from 2020 to 2025, report that no single surface modification has yet succeeded in simultaneously optimizing osseointegration and bacterial resistance. The results highlight, however, that nanostructured surfaces and laser treatments show the highest potential for improving long-term implant performance.

In concrete terms, for the practitioner:

• Favor implant systems using nanostructuring or laser treatment, as these technologies offer the best current compromise between bone anchorage and limitation of bacterial colonization.
• Strengthen maintenance protocols in patients receiving high-roughness implants, as data confirm that these surfaces facilitate early biofilm adhesion despite their mechanical benefits.
• Anticipate the integration of multifunctional coatings (ions, nanoparticles) as a future therapeutic lever to secure rehabilitations in patients with a history of peri-implantitis.

Technical lexicon of the study

Nanotopography: Surface modification at the nanometric scale (1-100 nm) aimed at influencing cellular behavior and bacterial adhesion through direct physical signals.

Anodization: Electrochemical process used to increase the thickness of the oxide layer on the titanium surface, allowing to modify its morphology and crystallinity.

Wettability: Ability of a liquid to spread over a solid surface, a determining factor for plasma protein adsorption and initial cellular adhesion.

Bioactive ceramics: Coating materials (e.g., hydroxyapatite) designed to induce a specific biological response at the interface, promoting the formation of a direct chemical bond with the bone.

Ion incorporation: Technique consisting of integrating elements (e.g., silver, copper, fluorine) into the implant surface to confer antibacterial properties or stimulate osteogenesis.

Laser surface treatment: Use of laser beams to create repetitive and ultra-precise surface patterns, improving implant purity and roughness without risk of contamination from blasting agents.

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