Treatment of peri-implantitis of extraoral craniofacial endosseous implants: a scoping review.

This scoping review was performed to synthesize the currently available evidence on the management of peri-implantitis affecting extraoral craniofacial endosseous implants, a condition that presents unique anatomical and microbiological challenges. Although a recently proposed treatment algorithm has gained attention in the literature, it is based on low-level evidence and is overly complex for routine clinical use, serving primarily as a conceptual or research-oriented framework. Pragmatic, evidence-based guidelines tailored to extraoral craniofacial endosseous implants remain lacking. JBI and PRISMA-ScR standards were followed to conduct a structured search, complemented by handsearching and reference screening. Eight studies met the inclusion criteria; only one was prospective. No added benefit was found for local antibiotics compared with mechanical cleaning using hydrogen peroxide. Lower-level evidence consistently emphasized meticulous hygiene instruction, mechanical debridement, and adjunctive topical antiseptics such as chlorhexidine or hydrogen peroxide. Systemic antibiotics guided by microbiological testing were recommended for advanced or refractory cases, whereas implant mobility uniformly indicated explantation. Increased peri-implant skin thickness was associated with poorer outcomes, suggesting a potential role for soft tissue thinning when surgically feasible. Overall, current treatment algorithms and available evidence are of limited practical value. High-quality, comparative research is urgently needed to establish evidence-based and clinically feasible treatment pathways as they have long existed in dental implantology. Future work should further define the indications, efficacy, and optimal use of specific agents to support the development of robust, practice-oriented therapeutic recommendations.