ABSTRACT Aim To investigate longitudinal changes in the submucosal peri‐implant microbiome during early healing and long‐term maturation, and their association with clinical and radiographic outcomes. Materials and Methods This is the 3‐year follow‐up of a subset of individuals from a randomized controlled clinical trial. Marginal bone level changes (MBL) were measured at implant placement, loading, 12 months, and 3 years; clinical parameters were recorded at 12 months and 3 years. Submucosal plaque samples were collected at 1 week, 4 weeks, and 3 years post‐implantation and analyzed by 16S rRNA gene sequencing. Microbial diversity, composition, and co‐occurrence networks were evaluated. Results Twenty‐seven patients (64 implants) completed the 3‐year visit. At 3 years, peri‐implant clinical conditions and MBL remained stable across visits, although early supracrestal remodeling was observed. The incidence of peri‐implant mucositis was 14.8% and peri‐implantitis 11.1% at patient‐level. Microbiome richness and phylogenetic diversity increased over time ( p < 0.0001). Early biofilms were dominated by facultative anaerobes (e.g., Haemophilus parainfluenzae , Neisseria elongata ), which declined at 3 years, when anaerobic/proteolytic taxa (e.g., Prevotella , Porphyromonas gingivalis , Fusobacterium nucleatum ) became more prominent. Presence/absence analyses at 3 years showed persistence of early colonizers alongside the integration of later‐arriving species. Lactococcus lactis and Enterococcus italicus increased in abundance and occupied more central positions in co‐occurrence networks. Conclusions Over 3 years, the peri‐implant microbiome matured into a more diverse and structured community, while MBL remained stable with physiological early supracrestal remodeling. These longitudinal findings suggest that early colonization and its subsequent evolution may influence long‐term peri‐implant health.
Vílchez et al. (Wed,) studied this question.