Background:
Implant surface modifications have evolved from turned surfaces to sandblasted large-grit acid-etched, chemically modified sandblasted large-grit acid-etched, anodized, and more recently multi-zone anodized surfaces. However, comparative long-term clinical data among these commonly used surfaces remain limited.

Purpose:
This retrospective study aimed to compare implant survival, marginal bone level change (MBLC), and peri-implantitis prevalence among four titanium surface modifications. Risk factors associated with these clinical outcomes were also analyzed.

Materials and Methods:
A total of 266 patients with 800 implants were included. Implant surfaces were categorized as anodized (n=217), multi-zone anodized (n=229), sandblasted large-grit acid-etched (n=116), and modified sandblasted large-grit acid-etched (n=180). Mean follow-up was 61.3 months. MBLC was assessed on periapical radiographs, and peri-implantitis was defined based on clinical and radiographic criteria. Statistical analyses included ANOVA, t-tests, and chi-square tests.

Results:
Overall implant survival was 92.7%, with no significant differences among surface modifications. Mean overall MBLC was −0.97 ± 1.00 mm, and peri-implantitis prevalence was 5.5%, with no significant differences among surfaces. Most marginal bone loss occurred before final prosthesis delivery. Soft tissue phenotype, keratinized tissue width, implant location, smoking, and prosthetic factors were associated with greater bone loss and peri-implantitis prevalence.

Conclusions:
Within the limitations of this retrospective study, implant survival, MBLC, and peri-implantitis prevalence were comparable among the four surface modifications.