Title: Psychosocial Stress, Social Determinants, and Biological Mechanisms in Peri-Implantitis: A Narrative Review of Interactions

This project presents a comprehensive narrative review investigating the biopsychosocial dimensions of peri-implantitis—a complex inflammatory condition affecting dental implants. By synthesizing evidence from 106 studies across human, animal, and mechanistic domains, the review explores how psychosocial stress (e.g., depression, anxiety) and social determinants of health (e.g., socioeconomic status, education, social isolation) interact with biological pathways such as HPA/SAM axis activation, oxidative stress, and immune dysregulation. The study introduces a conceptual model linking psychological and social adversity to peri-implant tissue breakdown, emphasizing the role of IL-6, TNF-α, cortisol, MDA, and SIRT1 as key biomarkers. This work advocates for interdisciplinary approaches in implant dentistry, integrating psychosocial screening and social context into clinical care. The review follows transparent screening, classification, and reporting protocols, and aims to guide future longitudinal research and personalized implant strategies.