The effect of surface porosity on performance of the nickel-titanium implant in posterior mandible

Background: Porous nickel–titanium (NiTi) alloys have emerged as promising biomaterials for dental and orthopedic use owing to their shape-memory effect, mechanical compatibility with bone, and intrinsic bioactivity. Although preclinical studies have confirmed their cytocompatibility and osteogenic potential, clinical validation in humans remains limited. Objective: This study aimed to evaluate the short-term clinical performance, peri-implant tissue response, and biological compatibility of NiTiDent Tuah, a porous NiTi dental implant, and to compare its outcomes with a commercially established titanium implant system (AnyRidge®). Materials and Methods: Thirty participants were recruited and randomly assigned to two groups (AnyRidge®, n = 18; NiTiDent Tuah, n = 12). Clinical parameters assessed included implant stability quotient (ISQ), peri-implant inflammation, bleeding on probing (BOP), probing depth (PD), and crestal bone level (CBL) across six follow-up intervals. Patient satisfaction (PSQ) and oral health-related quality of life (OHRQoL) were evaluated using the S-OHIP-14. Histopathological and energy-dispersive X-ray (EDX) analyses were performed on failed implants, while in vitro studies using human mesenchymal stem cells (hMSCs) assessed cell viability, alkaline phosphatase (ALP) activity, calcium deposition, and bone matrix formation. Results: AnyRidge® implants maintained high and progressively increasing ISQ values (mean 52.18 ± 13.63; p = 0.01). Peri-implant tissues were predominantly healthy (88.9%) with mild inflammation in 11.1%. Although CBL decreased from baseline to 22 weeks, bone height remained above the abutment–implant interface, with partial recovery noted by week 36. Patient satisfaction was high (mean PSQ = 6.01 ± 1.54), and OHRQoL improved significantly post-treatment (p < 0.001). NiTiDent Tuah demonstrated a significant reduction in ISQ values after 20 weeks (7.33 ± 11.67; p < 0.001). Histopathology revealed chronic peri-implantitis with foreign-body giant cell reactions, while EDX detected metallic contaminants (Al, Si, Mn, Fe, Cr) from degraded surgical drills. In vitro, NiTiDent Tuah supported strong hMSC adhesion, proliferation, osteogenic differentiation, elevated ALP activity, calcium deposition, and mature bone matrix formation after 28 days. Conclusion: Early clinical failures of NiTiDent Tuah implants were procedural, caused by drill wear and debris contamination rather than intrinsic material deficiencies. Porous NiTi exhibits strong bioactivity, osteoconductivity, and safety, reinforcing its promise as a next-generation implant material pending refinement of system-specific surgical instrumentation.