Abstract
BACKGROUND: Peri-implantitis, driven by microbial‒host immune interactions, is the leading reason that dental implants fail. Implant surface design plays a crucial role in microbial colonization. OBJECTIVE: To investigate how surface characteristics of implant materials impact periodontal disease biofilm formation and host immune response. DESIGN: Biofilms, cultured on Ti-6Al-4V and CoCr disks, had biomass quantified by crystal violet and microbial populations by agar enumeration. We assessed the influence of Ti-6Al-4V post-processing treatments on surface chemistry (energy dispersive spectroscopy), topography (optical profilometry) and microbial dynamics (through complex oral biofilm culture and 16S rRNA sequencing). To evaluate immune responses, biofilms were co-cultured with dysplastic oral keratinocytes, and IL-6, IL-8, IL-1β, TNFα and GRO-α ELISAs were performed. RESULTS: Sandblasting markedly increased surface roughness (3.9 vs 0.2-0.6 R(a)), biomass (0.72-0.99 vs 0.13-0.62 AU) and total viable counts (TVC). Ti-6Al-4V demonstrated significant enrichment of firmicutes compared to CoCr, together with increased proportions of sulphate-reducing and periodontal disease-associated taxa. Rougher surfaces provoked stronger immune activation under microbial challenge, highlighting the link between topography and host response. CONCLUSIONS: Surface roughness influenced biofilm formation and inflammation. Assessment of implant materials should integrate microbial and cellular responses for deeper insights. Smoother surfaces, combined with antimicrobial coatings may help reduce peri-implant disease.