Peri-implantitis is increasingly difficult to present to students solely as a local complication related to bacterial biofilm. Biofilm remains the starting point, but the course of the disease also depends on the host immune response, bone biology, systemic diseases, local factors, prosthetics, and long-term patient maintenance. The PERI-EDU project shows that modern teaching of peri-implantitis should move beyond the simple scheme of “bacterial plaque – inflammation – bone loss” and help students understand the disease as a complex biological and clinical process.
In dental education, peri-implantitis is often introduced as a topic related to complications of implant treatment. Students learn the definition of the disease, the difference between peri-implant mucositis and peri-implantitis, the importance of hygiene, bleeding on probing, pocket depth, and radiological bone loss. These are essential foundations and cannot be omitted. The problem begins when teaching stops at this level.
Peri-implantitis is not only a local inflammatory condition around an implant. It is a disease in which biofilm, host response, soft tissues, bone, implant surface, prosthetic restoration, and the patient’s systemic condition intersect. If students are to make responsible clinical decisions in the future, they should understand not only how to recognize bone loss, but also why in some patients the disease progresses faster, while in others it remains stable despite similar local conditions.
This is where the approach developed within the PERI-EDU project becomes particularly valuable. The project does not treat peri-implantitis as a simple technical or hygiene-related problem. It presents it as a multifactorial disease requiring the integration of knowledge from different areas: microbiology, immunology, periodontology, implantology, bone biology, diagnostic imaging, systemic diseases, and material science.
This way of teaching is important because biofilm is a significant condition, but it is not always sufficient to explain the course of the disease. Bacteria initiate the inflammatory response, but the patient’s organism determines how strong this response will be, how long it will persist, and whether it will be effectively resolved. In chronic inflammation, pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α play a particularly important role, as they may promote osteoclast activation and bone resorption. For students, this is an important lesson: bone loss around an implant is not only a radiological finding, but the result of specific biological mechanisms.
Modern teaching should also clearly distinguish peri-implantitis from periodontitis. Comparing these diseases is useful, but it should not lead to the simplified assumption that an implant behaves like a tooth. Peri-implant tissues are organized differently, there is no periodontal ligament, and the connection with bone is based on osseointegration. These differences influence the course of inflammation, the rate of bone loss, and the regenerative potential of tissues. When students understand this distinction, it becomes easier for them to appreciate why regular implant monitoring is so important and why even minor signs of inflammation should not be ignored.
It is equally important to include systemic factors in teaching. Diabetes, obesity, metabolic syndrome, cardiovascular diseases, osteoporosis, and autoimmune disorders should not be presented only as a list of medical conditions in the patient history. In the context of peri-implantitis, students should understand that these conditions may influence the inflammatory response, healing, bone metabolism, and tissue susceptibility to destruction. This shifts teaching from the question “Does the patient have a systemic disease?” to a more clinically relevant question: “How may this disease modify the course of local inflammation?”
This approach also changes how treatment planning should be taught. Students should not analyze an implant in isolation from the whole patient. Risk assessment must include not only bone conditions, prosthetic design, and hygiene, but also history of periodontitis, smoking, chronic diseases, metabolic control, ability to maintain hygiene, and the predictability of long-term supportive care. Implant dentistry does not end when osseointegration is achieved. Long-term success depends on biological stability, and students must learn how to assess and monitor it.
Clinical cases may be particularly useful in education. Instead of teaching peri-implantitis only through definitions, it is worth presenting students with real clinical situations: a patient with good hygiene but poorly controlled diabetes; a patient with a history of periodontitis and an apparently stable implant; a patient with slight bleeding around an implant but progressive bone loss; or a patient whose problem is related not only to biofilm, but also to prosthetic design and limited access for cleaning. Such examples teach students to connect facts rather than reproduce schemes.
In this sense, PERI-EDU can support a change in academic education. It encourages a transition from teaching peri-implantitis as an isolated topic within implant dentistry to presenting it as a model example of an interdisciplinary disease. It is a condition that requires students to understand biofilm, immune response, bone resorption, systemic disease, clinical diagnostics, and prosthetic decision-making at the same time.
This model of education is also important for academic teachers. It allows courses to be built in a way that connects basic science with clinical practice. Immunology, microbiology, and pathophysiology are no longer abstract subjects from earlier years of study. They become tools needed to understand the real implant patient.
The main goal is not for students to memorize more isolated facts about peri-implantitis. The goal is for them to learn causal and clinical thinking. Why did inflammation develop? Why is the disease progressing? Which local and systemic factors may intensify it? What can be monitored? When is more intensive supportive care needed? When should a local problem around an implant prompt a broader assessment of the patient?
Peri-implantitis is a good example of what modern dental education should look like: less focused on simple definitions and more focused on understanding processes. Biofilm, inflammation, and bone loss remain fundamental, but they do not exhaust the topic. Students should see the implant not as an isolated structure, but as an element functioning in a living organism, influenced by biological, mechanical, and systemic factors.
This perspective is one of the most important elements of PERI-EDU. The project shows that current research on peri-implantitis can and should be translated into academic teaching. If future clinicians are to diagnose, monitor, and treat peri-implant tissue diseases more effectively, they must learn to understand them as complex, multidimensional processes. Education should reflect this complexity.
Educational recommendations
- Teach peri-implantitis as a multifactorial disease, not only as a local bacterial complication around an implant.
- Keep biofilm as the starting point, but consistently show students the role of host response, cytokines, osteoclastogenesis, systemic diseases, and local factors.
- Compare peri-implantitis with periodontitis carefully, emphasizing differences between tissues around teeth and implants and their relevance for disease progression.
- Use clinical cases in teaching to show that similar local findings may have different significance depending on periodontal history, systemic diseases, prosthetic factors, and supportive care.
- Teach students to think about the patient, not only the implant, because long-term treatment stability depends on biology, hygiene, systemic risk, and continuous monitoring.