In recent years, a great number of different implant systems varying in materials, surface structure, and macroscopic design have been introduced to the dental market [1]. In studies using implants with modified surfaces, it was concluded that rough surfaces induce a stronger initial bone response, achieve stability more rapidly, and integrate more fully with extant bone [2,3,4,5,6]. Dental implants with oxide-coated (anodised) surfaces have demonstrated, in histologic and histomorphometric examinations, that the newly formed bone infiltrates the pores of the surface oxide layer and thereby establishes a strong interlock between the bone and oxidized implant [7,8,9]. The oxide-coated implant surface is categorized as “moderately rough,” typically with a thickened titanium oxide layer of high crystallinity and phosphorous content.

A prospective long-term clinical study on implants with oxide-coated surfaces revealed an implant survival rate of 99.2% and mean marginal bone loss of 0.7 ± 1.35 mm after 10 years of function [10]. Only 1.9% of the implants showed significant marginal bone loss (> 3 mm) together with bleeding on probing and suppuration. In a retrospective study, no difference could be found when comparing the clinical performance (survival rate, marginal bone loss, presence of bleeding, and probing depth) of turned versus oxide-coated surface implants after 5 years of loading [11]. In a 9-year study with an immediate loading protocol, implants with oxide-coated surfaces achieved a 10% higher survival rate compared to turned surface implants [12].

These results indicate that the survival rate of dental implants in long-term studies seems to be high, irrespective of surface type. However, the influence of the implant surface type on the development and progression of mucositis and peri-implantitis especially in periodontally diseased subjects remains largely unknown. In animal studies, it has been suggested that oxide-coated implants are more susceptible to mucositis and peri-implantitis [13,14,15]. Whether or to what extent these findings might be translated to humans is yet unknown. A Cochrane review found no evidence of a superior long-term success that could be attributed to any one type of implant surface [1]. Furthermore, the review concluded that there are limited data suggesting that implants with relatively smooth surfaces are less susceptible to peri-implantitis-induced bone loss.