Does the implant surface affect peri-implantitis? Polished vs rough, by the evidence

An implant surface is the texture of the titanium that touches bone and gum, and it comes in three main finishes: turned (machined), moderately rough and polished. Whether the finish changes peri-implantitis risk is unproven, and the evidence below is mixed. Three finishes come up in this debate.

A turned, or machined, surface is the original finish. A 2019 systematic review describes it as minimally rough, with a roughness of about 0.5 to 1 micrometre (Sa) (Saulacic and Schaller 2019).

A moderately rough surface is made by blasting or acid etching, techniques developed to improve how the implant fuses with bone, a process explained in our guide to osseointegration. A polished shaft is smooth where the implant crosses the bone crest and the gum.

The corticobasal implants described in a foundation consensus document have an apical cutting thread and a polished shaft (Antonina et al. 2020); it was issued by the International Implant Foundation, whose board approved it, so treat it as a description of the design rather than neutral evidence.

The 2019 review opens with the tension behind this guide: a moderately rough surface may improve bone integration, but the added roughness might affect how peri-implantitis starts and develops. Whether the finish of a titanium implant changes the risk of inflammation around it is the question the studies below try to answer.

The most direct evidence is a 2019 systematic review that compared rough and turned surfaces. It covered 2,992 implants, 1,083 turned and 1,909 rough. Its abstract counts eight articles and its results text seven; both give the same implant total.

A meta-analysis was not feasible because the studies differed too much, and the included studies used eight different diagnostic criteria for peri-implantitis (Saulacic and Schaller 2019).

The 2019 review concluded that a rough surface does not seem to increase the incidence of peri-implantitis compared with a turned one. The review's own table lists 97 cases among the turned implants and 234 among the rough ones. Worked out from those counts, that is roughly 9% against 12%, an unadjusted figure that mixes different studies, so read it as a reminder of how loose the evidence is rather than as a result.

Over the long term, turned surfaces showed more bone loss at several time points; the plaque differences were not statistically significant.

A Swedish study of 588 patients examined nine years after treatment found peri-implantitis in 45% of patients and moderate or severe disease in 14.5%.

Patients with gum disease, those with four or more implants, and those with implants of certain brands had higher odds of moderate or severe disease; the abstract does not name the brands, and no independent brand ranking comes out of it (Derks et al. 2016, abstract only).

To put a scale on the problem, a 2022 meta-analysis of 57 articles reported peri-implantitis in 19.53% of patients and 12.53% of implants, and noted that the diagnostic criteria changed the figures (Diaz et al. 2022).

A 2025 AO/AAP meta-analysis found 22% of patients affected after 5 to 10 years of loading and 19% after 10 to 20 years (Galarraga-Vinueza et al. 2025).

Claims that polished surfaces prevent peri-implantitis come from papers written by, or closely tied to, the people who developed the concept or the foundation that teaches it. That does not make them wrong. It does mean they deserve a different weight, and none of them had a comparison group.

One prospective series reports that more than 5,100 corticobasal implants were placed over 12 to 57 months and states that peri-implantitis was not observed, but it gives details for 1,169 of them and about a third were followed by patient interview only (Lazarov 2019).

A later retrospective series of 5,108 implants recorded 154 failures and reported that none of the implants showed signs of peri-implantitis, which the authors credit to the polished surface (Patel et al. 2025).

A report on a single patient followed for 20 years found no bone loss around lateral basal implants with fully polished vertical parts and crater-like bone loss around an implant with a ribbed, sandblasted shaft (Ihde and Ihde 2018). The authors themselves note they cannot tell whether sandblasting alone would have caused the same loss.

Two more details change how to read these papers. The first comes from the 5,100-implant author, who wrote that specific surface characteristics play no role in implants designed for immediate loading, because bone does not heal or integrate the implant within 72 hours (Lazarov 2019). By that logic the surface is not the reason such implants hold.

The second is that a developer-linked series of 1,057 one-piece compressive implants, which shares an author, Pałka, with Lazarov's group and which reports no external funding, describes its implants as rough surfaced and warns that exposed rough surface will invite bacteria and peri-implantitis (Jani et al. 2022).

Polished and rough designs sit inside the same family of treatment.

The table sorts the studies above by how much weight each can carry on the surface question.

The developer-linked rows describe screw-type corticobasal implants; the single-patient report describes older lateral basal plates. None of the rows compares polished and rough implants head to head in the same type of patient.

The 2025 AO/AAP consensus, a joint report of the Academy of Osseointegration and the American Academy of Periodontology, lists the risk markers for peri-implantitis. It rates implant malposition, a history of periodontitis, active periodontitis, uncontrolled diabetes and being a current or former smoker as high risk.

Interimplant distance below 3 mm and a prosthesis that sits close to the bone are rated moderate risk. The same report notes that comparative studies have not shown any implant macro or micro design to be superior for preventing peri-implant disease, while its experts agreed that design may still influence risk.

Surface is therefore not irrelevant, but it is one item on a longer list (Wang et al. 2025).

The 2019 review points the same way. It calls periodontitis and smoking the two most common patient-related risk factors for biological problems (Saulacic and Schaller 2019).

The AO/AAP evidence review adds that periodontitis and smoking were risk indicators for both mucositis and peri-implantitis, with diabetes and alcohol as potential risk indicators for peri-implantitis (Galarraga-Vinueza et al. 2025).

Our guide to smoking and diabetes with implants covers those two in detail, and treating gum disease first is a standard part of planning.

Hygiene routines matter too. The consensus text names lack of enrolment in a preventive maintenance program among the risk factors alongside periodontitis, diabetes and smoking, and calls supportive maintenance essential (Wang et al. 2025).

Daily dental plaque removal under a fixed bridge depends on how the bridge is shaped, so its design deserves as much attention as the implant surface. Our guide to peri-implant care covers cleaning routines and early warning signs.

Nexwell reads this evidence as follows. Treat a surface claim as one line in a plan, not as the reason to choose a clinic. A polished shaft may well help gum tissue, but the studies that say so cannot separate the surface from the rest of the concept: the one-piece body, the bridge, the patient selection and the follow-up. Independent data on the surface are less dramatic, and they favour neither side.

In Dt. Yıldırım's experience, peri-implantitis is rare on polished surfaces; when it appears, the cause is usually gum disease or general health. That is one clinician's practice, not a controlled finding, and the independent data above do not settle it. To look for the cause, he checks the gum with a probe for pus, examines the lymph nodes and takes an X-ray.

What we would ask a plan to show is what it does about your own risk factors and how the bridge will be cleaned. A system with a long, independently studied record counts for more than a surface label. Apart from the experience attributed to Dt. Yıldırım, this section is Nexwell's editorial framing, not a quotation from any study.

These six questions turn the evidence into a checklist you can take to any consultation.

1. Which implant system and surface will you use, and why? 2. Is there follow-up data from teams independent of the manufacturer or concept developer? 3. How would my gum disease history, smoking or diabetes change the plan? 4. Can I clean under and around the bridge, and how will you show me? 5. What is the maintenance interval, and who carries it out? 6. How do you diagnose and treat peri-implantitis if it happens?

In Dt. Yıldırım's practice, cleaning is taught as a routine. Where there is a gap under the bridge, thin interdental brushes are used, and a mouthwash twice a week is advised in every case. Check-ups with a professional clean take place every 6 to 24 months.

Between 24 and 72 months, if needed, the bridge may be removed so the fit with the gum can be checked and the inner surface, which cannot be seen, can be cleaned.

For higher-risk patients, smoking adds risk because it reduces the blood supply to the gum. After an extraction, he advises no tobacco at all for 5 days. If a patient chooses otherwise, the risks are explained and recorded. In his experience, diabetes that is not advanced affects the result less than people expect, although the published consensus still treats poorly controlled diabetes as a higher-risk factor.

If you would like these questions answered against your own scan, you can request a case review.

The AO/AAP consensus describes the first stage, mucositis, as inflammation with bleeding or pus (suppuration) that can progress to peri-implantitis if not addressed, meaning persistent inflammation and loss of the bone that supports the implant (Wang et al. 2025).

Our guide to peri-implant care lists the warning signs and what to do at home. Treatment options and what happens when an implant cannot be kept are in implant failure and salvage. Because the disease is defined by bone loss, an early review matters more than the implant surface.

For background on lifespan, see how long dental implants last.

Three other Nexwell guides cover neighbouring questions. Basal implants vs conventional implants reads the studies behind the corticobasal approach. One-piece vs two-piece dental implants deals with the neck and the connection. Cortical anchorage explains how some implants are held in dense bone, and who cannot get dental implants lists medicines and conditions that change a plan.

Brand differences are compared in dental implant brands, and the part that connects implant and crown is explained in the abutment guide.

Each figure above comes from these papers. Links open the PubMed record. Derks 2016 has no open full text and is cited only for its abstract.

1. Saulacic N, Schaller B. J Oral Maxillofac Res 2019;10(1):e1. PubMed 31069039, PMC6498817.

2. Wang HL, et al. AO/AAP consensus on prevention and management of peri-implant diseases and conditions: summary report. J Periodontol 2025;96(6):519-541. PubMed 40501397, PMC12273748.

3. Galarraga-Vinueza ME, et al. J Periodontol 2025;96(6):587-633. PubMed 40489307, PMC12273760.

4. Diaz P, et al. BMC Oral Health 2022;22(1):449. PubMed 36261829, PMC9583568.

5. Derks J, et al. J Dent Res 2016;95(1):43-49. PubMed 26701919.

6. Lazarov A. Ann Maxillofac Surg 2019;9(1):78-88. PubMed 31293933, PMC6585197.

7. Patel KB, et al. Ann Maxillofac Surg 2025;15(1):56-60. PubMed 40765890, PMC12321181.

8. Ihde S, Ihde A. Ann Maxillofac Surg 2018;8(2):365-368. PubMed 30693267, PMC6327802.

9. Jani M, et al. Healthcare (Basel) 2022;10(4):598. PubMed 35455776, PMC9024819.

10. Antonina I, et al. International Implant Foundation consensus on 16 methods. Ann Maxillofac Surg 2020;10(2):457-462. PubMed 33708595, PMC7944016.

This page was prepared by the Nexwell Team on 1 November 2026. Medically reviewed by Dt. Mehmet Salih Yıldırım, DDS, PhD.