Impact of Supportive Peri-Implants Care Instruments on Implant-Abutment Surface Integrity: A Systematic Review of Quantitative Studies

Background & Aim: To systematically analyze the impact of Supportive Peri-Implant Care instrumentation on the surface of dental implants and abutments. Methods: A systematic research was conducted in PubMed, Scopus and Web of Science in June 2024 and the screening phase ended on September 2024. Only quantitative studies analyzing surface alterations caused by physical, mechanical and chemical decontamination methods were included. Risk of bias in included studies was assessed. Results: Data from 29 in vitro studies were included. Surface alterations were assessed using profilometer and microscope and were reported through Ra, Rz and Sa roughness parameters. Difference in surface roughness between control and test groups were evaluated. For Ti machined surfaces, the surface roughness increases or decreases in 96% of cases for Ra and in 100% for Sa and Rz, with no consistent pattern. In contrast, Ti treated surfaces generally show more reduction in roughness parameters following instrumentation. Specifically, Rz and Ra consistently decreased across all type of instrumentation, while Sa parameter showed no consistent trend across studies. Alterations on Zirconia surface were minimal, with Ra changes between −0.05 to 0.06 and Sa between 0.2 to 0.8 microns. Conclusions: Due to the variability of results across the studies, no universally safe tool for maintaining surface integrity can be clearly identified. These results highlight the complexity of the topic and lead to the conclusion that the variability of roughness parameters, measurement technique, instrumentation protocols and type of implant surface significantly influence the results. Another aspect that emerges is a general lack of thorough knowledge on the real clinical implications linked to superficial alterations. In conclusion, in accordance with the recent EFP guidelines and the state of knowledge, preventive strategies and minimally invasive approaches remain fundamental to maintain peri-implant health, but further investigations with more homogeneous and standardized parameters are strongly needed to define the most correct procedure.