Reassessing Osseointegration Kinetics in Titanium Implants: The Underestimated Role of Periimplant Sulcular Microbiota in Early Crestal Bone Remodeling

Abstract

Osseointegration has long been conceptualized as a predominantly biomechanical phenomenon governed by implant surface topography and host bone density. However, emerging evidence suggests that periimplant sulcular microbiota exert a measurable modulatory influence on crestal alveolar bone remodeling within the critical 0–12 week healing window. This study employed 16S rRNA metagenomic sequencing, micro-computed tomography (micro-CT), and quantitative histomorphometry in a longitudinal cohort of 84 implant-receiving patients to reassess early osseointegration dynamics. Our findings demonstrate that dysbiotic shifts toward Treponema denticola and Prevotella intermedia dominance correlate significantly with accelerated marginal bone loss (MBL) independent of established prosthetic loading parameters. These results challenge the canonical implant success criteria outlined in the Albrektsson threshold model and advocate for sulcular microbiome profiling as a standard perioperative diagnostic protocol.