Beyond the Implant: Towards a Predictive, Preventive, Personalized and Participatory Approach to Patient-Centered Implant Dentistry—A Narrative Review

Abstract

Contemporary implant dentistry achieves remarkable survival rates, yet the rising prevalence of peri-implantitis and increasing patient complexity reveal the limits of a technically centered model. This narrative review synthesizes current evidence supporting the four pillars of the 4P framework—predictive, preventive, personalized, and participatory—and proposes an integrated patient-centered clinical algorithm for implant dentistry. Throughout this review, “4P” is used as the preferred designation; “P4 medicine” appears only in direct citation of original systems-medicine sources. A narrative literature search was conducted in PubMed, Scopus, and the Cochrane Library (January 2000 to June 2026). Reporting followed Scale for the Assessment of Narrative Review Articles (SANRA) Predictive tools—resonance frequency analysis, genomic biomarkers [investigational], artificial intelligence algorithms, and radiomic analysis—contribute to individual risk stratification, with variable levels of clinical validation. Preventive strategies anchored in a four-level continuum are associated with a peri-implantitis frequency of 18% in maintenance-compliant patients versus 43.9% in non-compliant patients, illustrating the measurable clinical impact of the preventive pillar. Personalized approaches optimize osseointegration according to each patient’s biological profile. Participatory implantology, through shared decision-making and patient-reported outcome measures, improves the therapeutic alliance and long-term adherence. The 4P model constitutes a coherent and clinically applicable conceptual framework. Its novel contribution is a sequential decision-making logic distinguishing pre-placement gate-keeping from post-placement dynamic pillar reorientation, providing clinicians with a structured conceptual framework applicable at each phase of implant treatment.