Document Type : Review Article
Authors
1 Dept. of Oral and Maxillofacial Pathology, Dental School, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
2 Dept. of Prosthodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
Abstract
This review aimed to comprehensively characterize implant-associated lesions and pathological conditions in dentistry, with particular emphasis on their clinical, radiographic, histopathological, and microbiological features, as well as their potential risk factors and underlying mechanisms. PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched for English-language articles published from 2016 to July 2025 using predefined keywords and Boolean combinations related to dental implants, implant-associated lesions, peri-implant diseases, and pathological conditions. Studies addressing clinical, radiographic, histopathological, or microbiological aspects of implant-associated pathology were eligible. Two reviewers independently screened the retrieved records, assessed potentially eligible full-text articles, and resolved disagreements by consensus or consultation with a third expert. Of the 52 articles identified through the search and screening process, 16 met the predefined eligibility criteria and were included in the qualitative synthesis. Peri-implant mucositis and peri-implantitis represented the most extensively characterized conditions, with peri-implantitis associated with inflammatory tissue destruction and progressive supporting bone loss. Implant periapical lesions showed distinct clinical and radiographic characteristics and were differentiated from conventional peri-implantitis. Reactive lesions, including fibrous hyperplasia and granulomatous lesions, were associated with chronic irritation, inflammatory stimuli, and foreign material. Histopathological evidence also demonstrated titanium-associated tissue reactions, including foreign-body responses and metal-induced inflammation. Systemic, surgical, anatomical, prosthetic, microbial, and biomaterial-related factors were identified as potential modifiers of lesion development and progression. The heterogeneity of the included evidence supported qualitative rather than quantitative synthesis. Implant-associated lesions comprise a heterogeneous group of infectious, inflammatory, reactive, and foreign-body-related pathological conditions with distinct clinical, radiographic, and histopathological characteristics. Early recognition through appropriate clinical and radiographic assessment, supplemented by histopathological and microbiological evaluation when indicated, is important for accurate diagnosis and management. Further well-designed clinical and histopathological studies are needed to strengthen the evidence base and establish more consistent diagnostic and management approaches.
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