Precision immunopharmacology in peri-implantitis management: from molecular mechanisms to advanced therapeutic strategies

Objectives To review the evolving shift in peri-implantitis research from traditional mechanical debridement toward host-modulatory and immunopharmacological concepts, focusing on molecular pathogenesis, candidate therapeutic targets, and advanced drug delivery systems requiring further validation. Methods A comprehensive literature review was conducted to synthesize current evidence on the osteoimmunology of peri-implantitis, including findings from single-cell RNA sequencing, studies on host-modulation therapies, and developments in nanotechnology-based delivery platforms. Results Peri-implantitis is increasingly recognized as an immunologically complex condition, with descriptive single-cell studies suggesting cell-interaction patterns such as the CXCL13+ fibroblast-CXCR2+ neutrophil axis. Candidate therapeutic strategies include targeted anti-cytokine biologics, specialized pro-resolving mediators (SPMs), and macrophage-directed approaches, but most remain preclinical or early translational. Advanced delivery systems such as stimuli-responsive hydrogels and exosome-based platforms may support localized treatment, while machine-learning models show promise for risk stratification but require prospective clinical validation. Conclusions Emerging immunopharmacological strategies, together with biomarker diagnostics and artificial intelligence, may help move peri-implantitis management toward more proactive and personalized care, provided that their mechanistic relevance and clinical utility are validated in rigorous studies.