Peri-implantitis progression and modulating factors: evidence synthesis and implications for clinical management

Peri-implantitis is a biofilm-related disease characterized by inflammation and tissue damage in the peri-implant mucosa, along with progressive loss of supporting bone. Although triggered by a polymicrobial biofilm, disease progression is influenced by factors beyond microbial buildup. This thorough review explores factors that may promote peri-implant disease progression, focusing on interactions among biofilm dynamics, local conditions, patient-related factors, and material-related characteristics. Evidence suggests that biofilm maturation, ecological imbalance, and ongoing inflammatory response are key drivers of disease progression. Locally, microbial shifts, iatrogenic conditions, and reduced cleanability seem to facilitate microbial buildup and hinder maintenance. Patient factors such as a history of periodontitis, smoking, and poorly controlled diabetes are most consistently linked to poorer peri-implant outcomes, while genetic susceptibility remains suggested but not confirmed. Material properties, including surface topography, roughness, chemistry, wettability, corrosion behavior, and particle release, may influence microbial colonization and host responses, though their independent clinical significance is less certain. Overall, current research points to a multifactorial model of peri-implant disease progression, though much of the evidence is based on observational studies with substantial heterogeneity, limiting the ability to draw definitive conclusions. A comprehensive understanding of microbial, biological, prosthetic, systemic, and material factors is crucial for accurate risk assessment, prevention, and personalized management of peri-implantitis.