Gyanda Mishra, Shubhnita Verma, Vinay Singh Parihar, Prasad Chitra
Surface modifications and antimicrobial interventions may reduce biofilm mass and/or bacterial viability on OMSIs. Current evidence does not support a clear association between quantitative biofilm reduction and improved clinical outcomes. However, qualitative bacterial differences may be associated with OMSI stability. Well-designed and standardized studies are needed to develop evidence-based biofilm management strategies for OMSIs.
BACKGROUND: The role of peri‑implant biofilm in the stability of orthodontic mini-screw implant (OMSI) remains poorly understood. This systematic review evaluated the effect of surface characteristics and antibiofilm strategies on biofilm formation and the impact of biofilm characteristics on OMSI stability.
METHODS: A systematic literature search was performed in Embase, PubMed (MEDLINE), LILACS, ScienceDirect, and Google Scholar through April 2026. Studies were selected based on predefined eligibility criteria. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the QUIN tool for in vitro studies. The protocol was registered with PROSPERO (CRD42024516882). Due to methodological heterogeneity across studies, the findings were qualitatively synthesized.
RESULTS: Twenty-three studies were included (18 in vitro, 4 observational, 1 randomized controlled trial). Surface roughness and carbon/oxygen content were positively associated with biofilm formation. Nano-engineered coatings (zinc oxide, titanium dioxide, silver/hydroxyapatite, chitosan-silver, biopolymer-embedded silver and selenium, plasma treatment) demonstrated antibiofilm or antimicrobial activity, although effects varied by coating composition and outcome assessed. Antimicrobial interventions (chlorhexidine, superoxidized gel, probiotics, herbal gels, photodynamic therapy, garlic extract) reduced bacterial viability and bacterial counts, although outcome measures and exposure protocols varied considerably. Dysbiotic communities enriched with periopathogenic taxa were reported in unstable OMSIs.
CONCLUSIONS: Surface modifications and antimicrobial interventions may reduce biofilm mass and/or bacterial viability on OMSIs. Current evidence does not support a clear association between quantitative biofilm reduction and improved clinical outcomes. However, qualitative bacterial differences may be associated with OMSI stability. Well-designed and standardized studies are needed to develop evidence-based biofilm management strategies for OMSIs.