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4 ISSN Print 0719-2460 ISSN Online 0719-2479. www.joralres.com/2020 In the biomedical area, implant infections are the most common and severe complication associated with the use of biomaterials. In many pathologies, the presence of pathogens and the infections could be resolved by the host immune system and/or antimicrobial therapy. However, the periodontal and peri-implant pathologies fit into the dysbiosis model of disease, where the recovery of the biological balance is necessary to maintain the health state, and antimicrobial treatment together with the host immune response alone is not sufficient, as the disease is the product of the imbalance between the bacteria and the host (dysbiosis), where the same bacteria present in health can now produce an infection.1 The characteristic of the site where the implants are installed allow contact between these devices and the bloodstream, mucosal membrane, skin in some case, among other tissues. As such a depressed immune area is formed, defined in the literature as a “locus minoris resistentiae” (LMR), by the loss of the indemnity of the body barriers and the presence of a foreign material. In the case of dental implants, this LMR considers the collagen fiber disposition, the loss of the original “junctional epithelium”, the surface treatment of the implant in contact with the tissues and the type of connection. This predisposes the implant to be colonized by bacteria, with the subsequent invasion of the peri-implant tissues.2 The risk of infection in dental implant is very high, due to the invasiveness of surgery in some case, the permanent presence of implant in the body, the contact with mucosal membranes, co-morbidities and critical state of the patients, which in a high number of cases are older adults, and by the proximity to critical sites like the brain and the heart.2 The adhesion of bacteria to the implant surface could be reversible by non-specific forces (electrostatic, hydrophilic and hydrophobic interactions) on a surface not covered with host protein, or irreversible due to specific forces in a surface covered with host protein, like collagen, bone sialoprotein, fibronectin among others. In this context, the majority of in vitro studies are limited, because they are not predictive regarding the behavior of bacteria towards the surface, inasmuch as the interactions between bacteria and implant surfaces depend of the type of bacteria, species, diversity, cellular cycle phase of the bacteria, etc., and generally these studies use a small number of Daniel Betancur.1 Camilo Ulloa.1

Invasion of peri-implant tissues by peri-implant pathogens: How close are in vitro models?