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 potential influence on osseointegration and peri-implant tissue stability. However, their actual clinical relevance in the prevention and progression of peri-implant diseases remains controversial. This systematic review aimed to synthesize the available clinical and microbiological evidence on the impact of different implant surface characteristics and surface modifications on peri-implant outcomes. Materials and Methods: Conducted according to PRISMA and registered in PROSPERO, an electronic search of PubMed, Scopus, and Web of Science (2015–2025) identified clinical studies assessing associations between implant surface characteristics/modifications and peri-implant clinical, radiographic, microbiological, or biomolecular outcomes. Risk of bias was evaluated using ROBINS-I. Results: Thirteen studies (randomized, controlled, and cohort designs) were included. Most trials reported minimal differences in marginal bone loss and periimplant parameters across surfaces. Potential advantages were mainly observed during early healing or in compromised bone. Long-term evidence emphasized the predominance of patient- and site-related risk factors. Microbiological outcomes were scarce and heterogeneous. Conclusions: Implant surface modifications appear to exert a limited and context-dependent influence on peri-implant outcomes. Long-term peri-implant health is primarily driven by multifactorial interactions involving host, microbial, and clinical factors rather than surface characteristics alone.