Research advances in early diagnosis and treatment strategies for peri-implantitis: from microecology to regenerative therapy.

Peri-implantitis, a plaque-associated inflammatory disease characterized by progressive bone loss around functional implants, poses a significant threat to the long-term success of oral rehabilitation. The understanding of its etiology has evolved from a traditional infection model to a dysbiosis-based host-microbe interaction disorder model. This paradigm shift underscores the critical need for early detection and novel therapeutic strategies. This review comprehensively summarizes recent research advances within a logical framework: microbial dysbiosis, early diagnosis, treatment evolution, and regeneration. We detail the transition from a symbiotic microflora to a pathogenic biofilm, emphasizing key pathogens and host immune dysregulation mechanisms. The review evaluates the refinement of clinical and imaging diagnostics, the application of molecular biomarkers for early warning, and the emergence of point-of-care testing (POCT). Treatment strategies are discussed, moving beyond mechanical debridement to include innovative approaches like microecological modulation and regenerative therapies employing guided bone regeneration (GBR), bioactive factors, and tissue engineering concepts. Finally, we address current challenges in clinical translation and highlight future directions, including integrated diagnostics, personalized minimally invasive treatment, and smart biomaterials. The effective management of peri-implantitis necessitates an integrated strategy combining microbiological control with predictable tissue regeneration, requiring interdisciplinary collaboration to ensure the long-term stability of implant restorations.