Microenvironmental Control of Dental Implant Osseointegration

Abstract

The dental implant interface (DII) constitutes a highly specialized and dynamic microenvironment that emerges immediately following implant placement and governs the biological success or failure of osseointegration. Distinct from native bone healing, the DII is shaped by the presence of a permanent foreign biomaterial, surgical trauma, host immune responses, and evolving mechanical stimuli. This review synthesizes contemporary evidence from periodontology, molecular biology, and biomaterials science to provide an integrated, phase-dependent framework of repair and osseointegration at the DII. We delineate the temporal progression of healing into hemostatic, inflammatory, proliferative, and remodeling phases, highlighting the molecular signaling networks, cellular dynamics, and mechanobiological cues that regulate each stage. Particular emphasis is placed on osteoimmunological mechanisms, including macrophage polarization and immune–bone crosstalk, as critical determinants of regenerative versus fibrotic healing outcomes. Additionally, the role of biochemical gradients, physicochemical conditions, and implant surface properties in directing protein adsorption, cell fate decisions, angiogenesis, and soft tissue integration is discussed. Translational implications for implant surface design, surgical protocols, and loading strategies are explored, underscoring the shift toward biologically intelligent and immunomodulatory implant systems. Finally, emerging approaches such as single-cell and spatial omics are presented as future tools to enable personalized implant therapy and improve long-term peri-implant tissue stability.