Chen, Stephen TMonje, AlbertoStrauss, Franz JSchwarz, FrankRoccuzzo, AndreaSailer, IrenaTarnow, DennisLambert, FranceJovanovic, SaschaBuser, Daniel2026-08-142026-08-142026-06-08Periodontology 2000 (2026) pp. 1–320906-671342253157https://hdl.handle.net/20.500.12254/7703The 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.enAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)clinician‐related errorshybrid implant designiatrogenic complicationsmicro‐rough implant surfacesperi‐implantitisprosthodontic errorssurgical errorsArticlehttps://orcid.org/0000-0002-2280-8480https://doi.org/10.1111/prd.700511600-0757