Regenerative Biomaterials and Emerging Biological Strategies for Peri-Implantitis: Current Clinical Evidence from a Structured Narrative Review

Abstract

Peri-implantitis is a plaque-associated inflammatory condition characterized by progressive loss of supporting peri-implant bone and remains one of the most challenging biological complications in implant dentistry. Although reconstructive procedures are increasingly used, the relative effectiveness of different regenerative biomaterials and biologically enhanced strategies remains uncertain. This structured narrative review critically evaluates current clinical evidence for regenerative biomaterials used in peri-implantitis treatment and places emerging biological and cell-based approaches within their appropriate translational context. A structured literature search was conducted in PubMed/MEDLINE. Particular emphasis was placed on direct human evidence concerning enamel matrix derivative, porous titanium granules, deproteinized bovine bone mineral (DBBM), hydroxyapatite, biphasic calcium phosphate, and platelet-rich fibrin, while periodontal, endodontic, and preclinical studies were considered indirect or translational evidence where relevant. Available clinical studies indicate that reconstructive procedures can improve radiographic defect fill and selected peri-implant clinical parameters; however, radiographic improvement does not necessarily correspond to complete disease resolution or true re-osseointegration. Among currently evaluated grafting materials, DBBM, porous titanium granules, and hydroxyapatite are supported by direct human clinical evidence, although heterogeneity in HA formulations and accompanying treatment protocols limits material-specific conclusions. BCP-containing reconstructive protocols have also been evaluated clinically, but the independent contribution of BCP remains difficult to isolate. Enamel matrix derivative and platelet-rich fibrin may provide biologically active adjunctive effects, although their independent contribution within multimodal regenerative protocols remains difficult to determine. Emerging cell-based and cell-derived strategies offer additional regenerative potential but remain predominantly supported by preclinical or translational evidence. No single biomaterial has demonstrated universal superiority. Future studies require standardized disease definitions, defect classifications, outcome measures, adequately powered multicentre trials, long-term follow-up, and improved patient and defect stratification to determine which regenerative strategies provide clinically meaningful and durable benefits.