Microbial and host-derived biomarkers for the diagnosis and management of peri-implant diseases.

OBJECTIVES: To critically evaluate the current evidence on microbial and host-derived biomarkers for the diagnosis and management of peri-implant diseases, with emphasis on their biological relevance, potential clinical utility, and current translational limitations. MATERIALS AND METHODS: A narrative review of the literature was performed, integrating evidence from clinical, translational, and experimental studies investigating molecular biomarkers in peri-implant health, peri-implant mucositis, and peri-implantitis. Evidence on detection methodologies, biological relevance, and associations with disease presence and treatment response was synthesized. RESULTS: Molecular approaches have identified distinct microbial profiles, host immune-inflammatory signatures, and metabolic patterns associated with peri-implant disease states. Microbiological biomarkers, including specific bacterial taxa and dysbiotic community shifts, provide insights into disease etiology, while host-derived biomarkers-such as cytokines, enzymes, and bone turnover markers-reflect underlying inflammatory and tissue remodeling processes. Emerging fields, including extracellular vesicles and metabolomics, further expand the repertoire of candidate biomarkers. Despite these advances, substantial heterogeneity in sampling protocols, analytical platforms, and case definitions limits comparability across studies. Consequently, no molecular biomarker or panel has yet achieved sufficient validation for routine clinical implementation. CONCLUSIONS: Molecular biomarkers hold significant promise for improving early diagnosis, risk stratification, and treatment monitoring of peri-implant diseases; however, their clinical translation remains constrained by methodological and validation challenges. To date, no single biomarker demonstrates sufficient accuracy or consistency to support standalone clinical use. Future progress will likely depend on integrative approaches combining multiple biomarker domains alongside clinical parameters to enable reliable and clinically applicable diagnostic strategies. CLINICAL RELEVANCE: Integration of microbial and host-derived molecular data, supported by standardized methodologies and robust clinical validation, may enable more precise, personalized approaches to peri-implant disease diagnosis and management.