Dental Luting Cements and Peri-Implantitis: Molecular Mechanisms, Clinical Implications and the Role of Autophagy and Nanotechnology-A Narrative Review.

Background and Objectives: This narrative review aims to evaluate the correlation between dental luting cements, peri-implantitis and the molecular mechanisms governing tissue destruction, with a specific focus on the role of autophagy and nanotechnology. Methods: A comprehensive literature search was conducted across electronic databases, including PubMed, Scopus and Web of Science, to identify relevant studies on cement cytotoxicity, cellular responses and nanomaterial integration. Results: Residual cement in the peri-implant sulcus promotes biofilm accumulation and severe inflammation. At a cellular level, resin-base monomers (e.g., Bis-GMA) impair human gingival fibroblasts via oxidative stress and mitochondrial dysfunction. Autophagy serves as a vital cytoprotective mechanism against cement toxicity and titanium particle accumulation. Experimental studies suggest that incorporating nanomaterials, specifically graphene oxide and silver nanoparticles (≤1 wt.%), has shown promising results in enhancing antimicrobial efficacy without compromising biocompatibility in vitro. Conclusions: To minimize peri-implantitis, clinical protocols should prioritize the meticulous removal of excess cement and the development of nano-reinforced luting agents. Optimizing these molecular pathways offers actionable preventive strategies, guiding clinicians toward safer cementation protocols and enhanced long-term implant success.