Critical appraisal of treatment modalities for peri‑implantitis (Review)

Peri‑implantitis is a biofilm‑induced, immune‑mediated inflammatory condition affecting ~1 in 5 patients bearing implants and remains one of the most clinically unresolved challenges in contemporary implantology. Although multiple therapeutic approaches have been proposed, no universally accepted treatment protocol exists, and the available evidence varies considerably in quality, consistency and long‑term predictability. The present critical narrative review, guided by the principles of the Scale for the Assessment of Narrative Review Articles (SANRA), critically evaluates the evidence supporting major treatment modalities for peri‑implantitis and synthesizes current knowledge into a clinically applicable, defect‑morphology‑based decision framework. A topic‑specific literature search was independently conducted by two authors across the PubMed/MEDLINE, Scopus and Google Scholar databases for English‑language publications from January, 2005 to December, 2025, covering six treatment categories. Non‑surgical therapy is an essential, yet insufficient during the first phase, requiring surgical intervention for moderate‑to‑advanced disease. Within the current comparative evidence, reconstructive therapy exhibits a signal favoring xenogenic over autogenous bone substitutes for contained intrabony defects, although no single graft material has demonstrated consistent superiority across all outcomes. Across both surgical and emerging therapeutic modalities, clinical outcomes appear to be influenced less by the specific decontamination instrument used than by surgical access, defect management, wound stability, and structured supportive maintenance. Emerging approaches, including laser‑assisted decontamination, electrochemical disinfection, autologous platelet concentrates and advanced drug‑delivery systems, demonstrate biological promise; however, they remain constrained by limited evidence quality, small sample sizes and insufficient long‑term follow‑up. Overall, peri‑implantitis management should evolve from a predominantly reactive treatment model toward a more predictive, preventive, personalized and participatory paradigm, extending the principles of P4 medicine proposed for periodontology to implant care.