Rough titanium implants are currently the standard treatment in implant dentistry [1]. They are roughly divided into three different types of surface roughness (S_a): machined/minimal (± 0.5 μm), moderate (1.0–2.0 μm), and rough (> 2.0 μm) [2]. Generally, rougher implant surfaces have greater bone-to-implant contact [3]. In a randomized controlled clinical trial, it has been demonstrated that higher initial clinical survival rates are achieved when implants with a moderate rough surface are used, compared with machined implants [4]. Moreover, greater forces are required for rougher surfaced implants to be removed [5].

On the other hand, a disadvantage of this increased roughness might be that it facilitates bacterial adhesion at the implant surface [6]. Once they become exposed, rough surface implants are more vulnerable to attract plaque. This disadvantage may entail that in some patients inflammation around rougher-surfaced implants might occur easier. Some patient groups are more vulnerable for this than others, e.g., periodontally compromised patients and smokers. They tend to have a higher risk of implant failure [7,8,9,10,11,12,13,14,15,16]. Clinicians are commonly placing dental implants with various surface roughness and modifications including plasma-sprayed, acid-etched, blasted, oxidized, hydroxyapatite-coated, or combinations of these procedures in these risk groups [17, 18].

In their systematic review, Saffi et al. have stated that periodontally compromised patients were significantly at higher risk of implant failure and increased marginal bone loss compared with periodontally healthy patients [19]. The microbiotic flora involved in peri-implant disease, i.e., peri-implantitis, resembles the flora associated with periodontitis [20,21,22]. Teeth might act as a reservoir for the colonization of the peri-implant sulcus. Within 2 weeks after one-stage implant placement or abutment connection in a partially edentulous patient, the peri-implant sulcus becomes colonized with bacteria similar to the neighboring natural teeth [23]. However, several other studies have reported no association between failing implants and history of periodontal disease [17, 24, 25]. Another systematic review on implant treatment in periodontally compromised patients has demonstrated high survival rates of implants in individuals with a history of periodontitis-associated tooth loss [26].