Galindo-Moreno, PabloGutierrez-Garrido, LourdesDuarte, JuanRobles-Vera, IñakiMartin-Morales, NatividadO'Valle, FranciscoOlaechea, AllinsonCarrillo-Galvez, Ana BelénPadial-Molina, Miguel2026-04-202026-04-202025-07Clin Oral Implants Res. 2025 Jul;36(7):802-820.https://hdl.handle.net/20.500.12105/27440To analyze the clinical, radiographic, and microbiological changes around implants with a multiphosphonate-treated surface, prosthetically loaded with two different protocols after 5 years of functional loading. A randomized clinical trial was designed to initiate prosthetic loading over single dental implants after 8 (control) or 4 weeks (test). Several variables were analyzed, including patients' level variables, intrasulcular biofilm, and marginal bone level at several time points, from 1 to 60 months after loading. A total of 23 patients attended the 5-year follow-up visit. No clinical variable changed over time, except mucosal thickness from dental impressions to prosthesis delivery. No significant radiographic differences were observed either over time or between groups. Microbiologically, there was a change in the microbiome from the constitution of the biological width to the final follow-up. Seven species changed significantly, with a significant increase in Porphyromonas gingivalis and Tannerella forsythia from 12 to 60 months and a decrease in the other species. However, changes in the relative abundance of species over time, whether increasing or decreasing, did not show a correlation with marginal bone loss. Implants with a multiphosphonate-treated surface showed no differences in clinical and radiographic variables after 5 years of function, regardless of the prosthetic loading protocol used. From a microbiological point of view, although there was an evolution of the microbiome in the peri-implant sulcus towards Socransky's red circle pathogenic bacteria, no microorganism showed a significant correlation with the radiographic changes produced in the peri-implant bone over time.This investigation was partially supported by the Research Cathedra MIS—University of Granada (funded by MIS Implants Technologies Ltd.), the Research Cathedra Dentsply Sirona—University of Granada (funded by Dentsply Sirona Iberia), by Grant PID2020-116347RB-I00 (funded by MICIU/AEI/https://doi.org/10.13039/501100011033), and by Research Groups #CTS-138, #CTS-164, #CTS-1028 (funded by Junta de Andalucía, Spain).engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/early loadingimplant surfacemarginal bone lossmicrobiomeperi‐implantitisAttribution-NonCommercial-NoDerivatives 4.0 International40062725Clinical Oral Implants Researchopen access