Advancing the diagnosis of peri‐implant diseases: From histological foundations to next‐generation ultrasonographic diagnostic markers

BACKGROUND: This critical review provides a comprehensive analysis of the histological foundations, current clinical diagnostic standards, and emerging ultrasonographic methods for diagnosing peri-implant diseases. METHODS: An electronic search in Medline (PubMed) database was conducted to identify original and review articles focused on the histological foundation and diagnostic approaches of peri-implant diseases. This review provides an integrated perspective on the evolution of peri-implant diseases diagnostics, focusing on the clinical and radiographic criteria established by the latest consensus guidelines. It outlines the histological features of peri-implant diseases and discusses recent advancements in ultrasonographic imaging approaches for their characterization and diagnosis. This review further explores elements such as peri-implant anatomical landmarks, echo intensity, tissue perfusion, and strain elastography. RESULTS: Histological studies have defined the peri-implant mucosal architecture and inflammatory patterns characteristic of disease progression. While conventional diagnostics have relied on clinical examination and radiographic imaging, high-frequency ultrasound (HFUS) has recently emerged as a promising noninvasive imaging tool enabling detailed assessment of peri-implant tissue dimensions, echo intensity, vascular perfusion, and the extent of inflammatory involvement. Echo intensity mapping aids in the visualization and quantification of peri-implant lesions and the identification of associated bone defects. These imaging advancements not only complement current diagnostic methods but also deepen our understanding of peri-implant disease dynamics. Observed correlations between histological findings and ultrasonographic features can support the development of a new diagnostic framework incorporating HFUS-derived markers for detecting peri-implant lesions and evaluating the severity of inflammation. CONCLUSIONS: Integrating HFUS and power Doppler imaging into peri-implant diagnostics allows real-time, noninvasive visualization of key structures such as the supracrestal adherent connective tissue, buccal bone levels, and tissue perfusion. These modalities can complement existing standards and enhance diagnostic precision by identifying the extent of peri-implant lesions and quantifying the severity of inflammation. PLAIN LANGUAGE SUMMARY: Peri-implant diseases can affect the tissues around dental implants and can lead to inflammation and bone loss. Understanding how these diseases develop and how best to diagnose them is essential for improving patient care. The present narrative review looked at scientific studies that examined the tissues around implants and the methods used to diagnose peri-implant diseases. It explains what researchers have learned from tissue (histological) studies and summarizes the current clinical and X-ray based diagnostic standards. It also highlights new advances in high-frequency ultrasound (HFUS), a technology that can provide detailed, real-time images of the soft tissues and bone around implants without radiation. Recent studies show that HFUS can measure tissue thickness, detect inflammation, visualize blood flow, and help identify early bone defects. These ultrasound features match what is known from histology, suggesting that HFUS could become an important tool for detecting peri-implant disease earlier and more accurately. Overall, adding HFUS and power Doppler imaging to current diagnostic methods can improve the evaluation of peri-implant tissues. These noninvasive techniques can help clinicians see key structures more clearly, assess inflammation, and better understand the severity of the disease.