1. Scope & Definitions Peri‑implantitis incidence: ~20–50 % of implants show bone‑loss lesions, but only a subset requires extraction.
Treatment success: 5‑year re‐treatment “success” rates hover around 50–60 %, heavily dependent on case selection and patient health.
2. The “Coffee‑Machine” Analogy (Fretwurst) Just as different coffee machines harbor distinct, complex bacterial communities, each patient’s peri‑implant microbiome—and their host immune response—forms a unique “fingerprint.”
Multi‑omic approach: Investigate not only species profiles, but also proteomic and metabolomic signals in peri‑implant crevicular fluid to identify personalized biomarkers.
3. Pocket‑Type Microbiota (Jönsson) Shared bacterial core: Porphyromonas, Tannerella, Treponema, etc., are enriched in both peri‑implantitis and periodontitis pockets.
Disease‑specific shifts: While a large overlap exists, subtle species‑level differences may help distinguish and target peri‑implant lesions.
Next step: Map inter‑species interaction networks and their cross‑talk with host cells.
4. Immune Modulation & Animal Models (Wilensky) Mouse micro‑implant model: 100 % bone loss observed over time—reflects uniform genetics and microbiota in rodents, unlike the human population.
Resolvins (e.g. RvD2): Endogenous lipid mediators that actively terminate inflammation and promote tissue healing.
In mice, systemic/local delivery of RvD2 arrested bone loss and downregulated pro‑inflammatory cytokines.
5. Translational Challenges & Future Directions Heterogeneity: Human genetic background, diet, comorbidities, and oral environments all modulate disease—rodent data must be validated in diverse patient cohorts.
Precision Implant Dentistry:
Biomarker panels (multi‑omic) to stratify patients into risk groups.
Tailored therapies—combining mechanical debridement, host‑modulation (resolvins, immunoregulators), and targeted antimicrobials.
Longitudinal monitoring via minimally invasive sampling (saliva, crevicular fluid).
Collaborative “Big Data” initiatives: – Standardize sample collection, metadata, and outcome metrics. – Share multi‑center cohorts to uncover robust patterns and validate biomarkers.
Key Take‑Away Peri‑implantitis is a multifactorial disease reflecting unique patient–microbe–immune interactions. Progress hinges on:
Multi‑omic characterization of individual lesions.
Immune‑modulating agents (e.g. resolvins) to complement mechanical therapy.
Large‑scale, standardized data sharing to unlock predictive, personalized treatment protocols.