Titanium Dental Implants and Peri Implant Infections: A Systematic Review
TL;DR
Current human evidence indicates a plausible association between titanium surface properties, particle release, and peri-implant inflammatory changes, but heterogeneity and small sample sizes limit firm conclusions.
Abstract
Background: Titanium and Ti-6Al-4V alloys are the dominant materials for dental implants because of their mechanical strength and biocompatibility, yet peri-implant infections remain a major cause of implant failure. We performed a systematic review to synthesize human clinical and in vivo evidence on the relationship between titanium implant surfaces, titanium particle release, and peri-implant infections. Methods: The systematic review was conducted according to the PRISMA guidelines. We searched PubMed, Embase, Cochrane Library, Web of Science, ScienceDirect and Google Scholar through April 2026 for studies reporting peri-implant infection, titanium particle/ion release, or biofilm formation associated with titanium dental implants. Two reviewers independently screened records, extracted data, and assessed study quality using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in study designs, outcomes and measurement methods, a quantitative meta-analysis was not performed; results were synthesized narratively. Results: Out of the 329 studies, 10 studies met the inclusion criteria (human clinical and intra-oral exposure models). Studies evaluated early biofilm formation on titanium surfaces, surface modifications, and titanium particle concentrations in peri-implant tissues. Evidence suggests that surface modifications can reduce early bacterial colonization in short-term intra-oral models, while several clinical studies report higher titanium particle concentrations at peri-implantitis sites, for which the causality remains uncertain. Conclusions: Current human evidence indicates a plausible association between titanium surface properties, particle release, and peri-implant inflammatory changes, but heterogeneity and small sample sizes limit firm conclusions. Well-designed prospective clinical studies with standardized outcome measures are needed to clarify causality and to evaluate whether specific surface treatments reduce infection risk.