Risk assessment and management strategies for peri-implantitis in high-risk populations⁠

Abstract

Peri-implantitis is a multifactorial condition characterized by inflammation and progressive bone loss surrounding dental implants, often leading to implant failure. High-risk populations, including patients with systemic conditions such as diabetes or undergoing cancer treatments, face an elevated susceptibility due to impaired immune responses and altered bone metabolism. Understanding the pathophysiological mechanisms underlying the disease is essential for effective risk assessment and management. Dysbiosis of the microbial biofilm, immune system dysregulation, and systemic factors like oxidative stress and cytokine imbalances are critical contributors to disease progression. These factors necessitate the development of targeted strategies for prevention and intervention. Risk assessment models have evolved to include advanced technologies such as artificial intelligence and decision tree regression to predict peri-implantitis in vulnerable individuals accurately. These tools incorporate systemic, local, and implant-specific parameters to enable personalized treatment planning and early intervention. Innovative management strategies have also emerged, ranging from adjunctive antimicrobial therapies, such as glycine powder air-polishing and localized drug delivery systems, to host modulation therapies and regenerative techniques. The use of advanced biomaterials, such as implants coated with bioactive peptides or antimicrobial nanoparticles, has further improved osseointegration and reduced infection rates. Regenerative approaches, including the application of growth factors like platelet-derived growth factor and bone morphogenetic proteins, have shown significant potential in repairing peri-implant defects and restoring functional stability. Emerging technologies, such as nanotechnology and bioengineered implants, offer new possibilities for real-time health monitoring and sustained therapeutic delivery at implant sites. These advancements, coupled with a deeper understanding of peri-implantitis etiology, provide a framework for optimizing outcomes in high-risk populations, addressing both the local and systemic challenges posed by the disease.