PERI-IMPLANTITIS PHENOTYPING AND MANAGEMENT: DIAGNOSTIC HETEROGENEITY AND THE EVIDENCE GAP IN IMPLANT SURFACE DECONTAMINATION AND RE-OSSEOINTEGRATION

Peri-implantitis is now recognised as the principal biological complication underlying late dental implant failure, yet the field continues to lack a single, universally applied case definition. Divergent probing-depth thresholds, inconsistent baseline reference points for marginal bone loss, and variable inclusion criteria across studies have produced prevalence estimates ranging from single digits to almost half of all implants surveyed, complicating both epidemiological comparison and clinical decision-making. Compounding this diagnostic heterogeneity is a second, related uncertainty: no decontamination protocol for the exposed implant surface has yet demonstrated clear superiority, and predictable re-establishment of true osseointegration (re-osseointegration) after treatment remains the exception rather than the rule. This narrative review synthesises the contemporary literature on peri-implantitis case definitions and clinical phenotyping, appraises the comparative evidence for mechanical, chemical, air-abrasive, laser-assisted, and electrolytic decontamination protocols, and evaluates surgical (resective and reconstructive) treatment outcomes with specific attention to histological and radiographic evidence of re-osseointegration. A structured search of PubMed/MEDLINE, Scopus, and the Cochrane Library was conducted for the period 2008–2026, prioritising World Workshop consensus reports, systematic reviews with meta-analysis, and randomised controlled trials. The findings confirm that diagnostic thresholds remain probe- and defect-morphology-dependent rather than universally fixed, that defect configuration is the dominant determinant of treatment selection, and that decontamination method choice appears less influential on clinical outcome than completeness of debridement, defect containment, and adherence to structured supportive peri-implant care. Emerging electrolytic and combined chemo-mechanical protocols show early histological evidence of re-osseointegration in humans, but the evidence base remains limited to small cohorts. Standardised, validated phenotyping frameworks and adequately powered trials with re-osseointegration as a histological endpoint are identified as priorities for future research.