Effect of Personalized Biofilm-Guided Supportive Care on Peri-Implant Tissue Stability: A Randomized Precision-Prevention Trial

Abstract

Long-term maintenance of dental implants depends on effective control of peri-implant biofilm and inflammation, yet supportive care is commonly delivered according to standardized recall intervals rather than individualized biological risk. This randomized clinical trial proposes to determine whether a personalized biofilm-guided maintenance strategy improves peri-implant tissue stability compared with conventional fixed-interval supportive care. Adults with at least one implant in function for more than one year and presenting with peri-implant health or mucositis will undergo baseline clinical, radiographic, microbial, salivary, behavioral, and prosthetic assessment. Participants will be randomly allocated to conventional six-month maintenance or precision maintenance in which recall intervals and preventive procedures are determined using a dynamic risk algorithm incorporating bleeding on probing, probing depth, previous periodontitis, smoking, glycemic status, plaque burden, prosthetic cleansability, salivary inflammatory markers, and targeted microbial measurements. Participants assigned to personalized care may receive maintenance at three-, four-, six-, or nine-month intervals, with risk recalculated following each visit. The primary outcome will be change in peri-implant bleeding on probing over 24 months. Secondary outcomes will include incident peri-implantitis, probing-depth changes, radiographic marginal bone loss, plaque levels, microbial dysbiosis, oral-health-related quality of life, treatment burden, and healthcare costs. Longitudinal mixed-effects models will compare inflammatory trajectories between groups, while time-to-event analysis will evaluate peri-implantitis development. A health-economic analysis will determine whether risk-adapted care reduces unnecessary visits among low-risk individuals while directing greater preventive resources toward susceptible patients. Changes in microbial community structure will also be assessed to establish whether clinical improvement corresponds with sustained ecological shifts in peri-implant biofilms. By testing personalized surveillance as an intervention rather than merely a predictive concept, this trial could provide direct evidence for precision prevention in implant dentistry. If successful, the strategy may replace uniform maintenance schedules with adaptive recall protocols based on continuously updated patient-specific biological and behavioral risk.