Peri-implantitis—Is it mainly a clinician-initiated complication of implant therapy?

The high prevalence of peri-implantitis is concerning, with a growing consensus that the majority of cases are complications initiated by clinician-related errors rather than classic pathology. A primary predisposing factor for peri-implantitis is exposure of the micro-rough implant surfaces to the peri-implant sulcus after treatment. Objectives: To identify surgical/prosthetic factors causing micro-rough surface exposure and advocate for prevention and evidence-based protocols. Materials and Methods: This paper reviews evidence linking surgical and prosthetic errors to micro-rough surface exposure to the sulcus and subsequent peri-implantitis development. Results: Surgical factors for surface exposure include malposition, avascular necrosis, and incomplete bone regeneration of peri-implant defects. Prosthetic factors include cement remnants and wide prosthetic emergence angles. Clinician-influenceable co-factors—including patient compliance, history of periodontitis, uncontrolled systemic factors/habits, lack of keratinized mucosa, prosthetic misfit, overcontoured/uncleansable prostheses, failure to detect early bone loss or mucosal changes, and inadequate maintenance—contribute to the initiation and progression of peri-implantitis once micro-rough surfaces are exposed. Conclusions: Most peri-implantitis cases are preventable complications. Professional education and research must prioritize identifying clinician-related errors and adherence to foundational treatment principles. This requires a paradigm shift toward a complication-based model of peri-implantitis. Clinical Relevance: To reduce the risk of peri-implantitis, clinicians should avoid clinical errors that lead to exposure of the micro-rough implant surface. Hybrid surface designs and subcrestal micro-rough surface placement should be considered as safety buffers. Success depends on meticulous diagnostics and planning, proper surgical/prosthetic execution, cleansable prosthesis design, and proactive maintenance to detect early bone loss and soft tissue changes.

Lugar de Publicación

Reino Unido

Citación

Periodontology 2000 (2026) pp. 1–32

Palabras clave

clinician‐related errors, hybrid implant design, iatrogenic complications, micro‐rough implant surfaces, peri‐implantitis, prosthodontic errors, surgical errors

Licencia

Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)

Licencia URL

http://creativecommons.org/licenses/by-nc-sa/3.0/cl/

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