Effects of Implant Silver Coatings on Bone Formation in Animal Models: A Systematic Review and Meta-Analysis

Background/Objective: Clinical statistics show that bacterial infection is a major driver of implant failure. To enhance antibacterial performance, some metallic elements, such as silver (Ag), zinc (Zn), and copper (Cu), are commonly used to modify the titanium surface. Despite the promising antibacterial performance of Ag, concerns persist regarding dose-dependent cytotoxicity, systemic accumulation, and potential effects on local bone metabolism. This review aimed to investigate the effects of incorporating or coating titanium (Ti) implant surfaces with Ag on bone formation around implants. Methods: A search was undertaken using three main databases (PubMed, Web of Science, and Scopus). The search was limited to studies published within the last 20 years that involved animal experiments using endosseous implants coated with or incorporating Ag. Meta-analyses were performed for bone-to-implant contact (BIC), bone formation (BA), and bone volume (BV/TV) around the implant in control and test groups. The compared groups were subjected to similar implant surface treatments aside from the presence of silver in the test group. Results: Sixteen studies met the inclusion criteria in this study and were included. The analysis of BIC values revealed a statistically significant overall effect in favor of silver-coated implants (Z = 2.01, p = 0.04), along with 95% confidence intervals (CIs). The BA analysis found no significant difference between silver-coated and control implants (Z = 1.09, p = 0.28). The BV/TV analysis also showed no statistically significant overall difference (Z = 0.35, p = 0.73). Conclusions: In animal models, silver-coated Ti implants improve bone–implant contact without altering peri-implant bone volume metrics.