Peri‐implantitis pathogenesis: Novel insights may guide therapeutic interventions

Concepts regarding the etiology and management of inflammatory lesions around dental implants continue to evolve. While bacterial biofilm is widely recognized as the primary etiologic factor, additional contributors such as excess cement and metallic particles acting as foreign bodies have been increasingly emphasized in the literature. These foreign materials act synergistically with biofilm to amplify the inflammatory response. Ions and particles released from implant surfaces can initiate an immunoinflammatory cascade, ultimately resulting in peri-implant bone loss, a process referred to as metallosis. Unlike the removal of excess cement, which can often be mitigated through judicious cementation techniques or, preferably, the use of screw-retained restorations, the reduction of metallic particles presents greater clinical challenges. Such particles may originate from biofilm-induced corrosion, occlusal overload, or even therapeutic interventions aimed at treating peri-implant inflammation. Minimally invasive strategies have been proposed to address these challenges. Approaches such as the careful use of cotton pellets with sterile saline, and when indicated, the application of minimally invasive flaps under enhanced visualization, have shown promise in reducing the burden of foreign particles. Importantly, stringent oral hygiene measures and consistent maintenance therapy remain indispensable in mitigating these risks and maintaining peri-implant health.