Do hydrophilic implant surfaces provide a clinically meaningful advantage?

Vílchez B, Caneiro L, Lima C, Sanz-Sánchez I, Montero E, Figuero E, Blanco J, Sanz M Clinical and radiographic performance of two distinct sandblasted, large-grit, acid-etched implant surfaces: A split-mouth randomized clinical trial. Clin Oral Implants Res. 2026;37:141-54. https://doi.org/10.1111/clr.70071 .

Among adults requiring bilateral implant-supported restorations in healed posterior sites, does a chemically modified hydrophilic sandblasted, large-grit, acid-etched (SLActive) implant surface provide superior peri-implant tissue outcomes compared with a conventional SLA surface after one year of functional loading?

Multicentre, split-mouth, randomized controlled clinical trial with blinded outcome assessment and 1-year follow-up after prosthetic loading.

Adults (≥18 years) requiring at least two implants in healed posterior ridges located in different quadrants were recruited from two university referral centers in Spain. Eligible sites had healed for at least 3 months after extraction and required neither simultaneous hard- nor soft-tissue augmentation. Exclusion criteria included uncontrolled systemic conditions affecting healing, poor oral hygiene (full-mouth plaque score ≥20%), heavy smoking (>10 cigarettes/day), pregnancy, untreated periodontal disease, severe parafunctional habits, insufficient keratinized mucosa (<2 mm), recent grafting procedures, or other local or systemic factors that could compromise osseointegration. Seventy patients were screened; 68 were randomized, each receiving one SLActive implant and one conventional SLA implant according to a split-mouth allocation (136 implants total). Owing primarily to early implant failures and protocol-related exclusions inherent to the paired design, 61 participants completed follow-up, while 56 contributed complete radiographic data for analysis of the primary outcome.

The primary endpoint was radiographic marginal bone level (MBL) change from prosthetic loading to 12 months. Secondary outcomes comprised MBL changes from implant placement, implant stability quotient (ISQ), wound healing, peri-implant clinical parameters, implant and prosthesis survival, adverse events, and oral health-related quality of life (OHIP-14). The patient served as the unit of analysis. Quantitative variables were analysed using paired Student's t tests and repeated-measures mixed ANOVA with Bonferroni adjustment, whereas categorical outcomes were compared using Wilcoxon or chi-square methods, with statistical significance set at p ≤ 0.05.

Sixty-eight patients (136 implants) entered the trial and 61 completed clinical follow-up. Early implant survival before loading was 95.5% for SLActive and 97.0% for SLA implants; no additional implant losses occurred after loading (100% post-loading survival). For the primary outcome, mean MBL change from loading to 12 months was -0.04 ± 0.39 mm for SLActive implants and -0.07 ± 0.22 mm for SLA implants (mean difference 0.03 mm; 95% CI - 0.09 to 0.14; p = 0.658). A statistically significant but small difference was detected for bone remodeling from implant placement to 12 months (0.20 ± 0.39 mm vs 0.06 ± 0.20 mm; mean difference 0.15 mm; 95% CI 0.02-0.27; p = 0.024). Implant stability (baseline ISQ approximately 73; 8-week ISQ approximately 76), wound healing, probing depth (2.61 vs 2.58 mm), bleeding on probing, peri-implant mucositis prevalence, adverse events, and patient-reported outcomes were comparable between groups. No cases of peri-implantitis were observed during follow-up.

Both implant surfaces achieved excellent short-term clinical performance. Although a small statistical difference in overall bone remodeling from implant placement to 12 months favored the conventional SLA surface, no clinically meaningful superiority of the hydrophilic surface was demonstrated for the prespecified primary outcome or for clinically relevant secondary outcomes after one year of functional loading.