Annan Chen, Ke Li, Yinjin Li, Che Fan, Zhiyao Zhang, Zhiyao Zhang, Yuanchao Liu, Jin Su, Yunsong Shi, Yunsong Shi, Huachen Cui, Kai Liu, Yusheng Shi, Yusheng Shi, Zhen Zhang, Zhen Zhang, Chunze Yan, Jian Lu
More than one-third of the global population suffers from dental defects, with osseointegrated implants being the gold-standard intervention; yet, their long-term functional performance is hindered by peri-implantitis. Here, we present an autonomous piezoelectric implant that delivers adaptive antibacterial and anti-inflammatory functionalities through physiological occlusal activation without any external intervention. The implant demonstrates good functional durability, sustaining consistent bioelectric outputs through over 1,000,000 loading-unloading cycles and exhibiting stable electrical performance in simulated physiological environments for over 30 days. Besides, integration with machine learning enables reliable, patient-specific prediction and real-time modulation of occlusal mechano-adaptive voltage responses. The autonomous implant achieves tri-modal therapeutic integration: (ⅰ) electrocatalytic bactericidal activity via controlled reactive oxygen species generation, (ⅱ) electrically induced immunomodulation of macrophages from pro- to anti-inflammatory phenotypes, and (ⅲ) electrostimulation-enhanced osteogenesis surpassing conventional titanium alloys, both in vitro and in vivo. These findings provide insights for occlusion-activated effective peri-implantitis intervention and a widely applicable strategy for developing autonomous and adaptable bioelectronic platforms. Long-term functional performance of dental implants is severely hindered by peri-implantitis. Here, the authors report an autonomous piezoelectric implant enables adaptive, durable antibacterial and anti-inflammatory functions via physiological occlusal activation without any external intervention.