MODERN CONCEPTS OF THE PATHOGENESIS OF PERI-IMPLANTITIS AND THE CONCEPT OF ITS TREATMENT

Relevance. The incidence of peri-implantitis in compromised patients reaches 22 %. Peri-implantitis is characterized as a multifactorial inflammatory disease, which is based on profound immune dysregulation. Aim: To analyze the literature, identifying significant factors in the pathogenesis of peri-implantitis in compromised patients and assessing the potential impact of various treatment strategies. Materials and Methods. We analyzed current (since 2021) scientific literature, consulting electronic databases such as PubMed, scholar.google.ru, eLIBRARY.RU, CyberLeninka, and others, using the keywords peri-implantitis, dental implantology, pathogenesis, modern treatment methods, and omics technologies in both Russian and English. General scientific research methods were used to identify cause-and-effect relationships. Results. The role of Gram-negative anaerobic bacteria – Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola – in the development of peri-implantitis has been demonstrated. A significant shift toward pro-inflammatory M1 macrophages (marker CD86) has been demonstrated in patients with peri-implantitis. The M1/M2 ratio positively correlates with clinical parameters of disease severity. Pro-inflammatory cytokines (IL-1β, IL-6, tumor necrosis factor α (TNF-α)) synthesized by M1 macrophages act as central regulators of the inflammatory process in peri-implantitis. Their concentration in peri-implant crevicular fluid (PICF) and surrounding tissues is currently considered an informative diagnostic marker for this disease. Conclusion. The integration of multi-omics platforms (genomics, transcriptomics, proteomics, metabolomics) within systems biology opens up fundamentally new possibilities for a deeper understanding of the pathogenesis of peri-implantitis and the creation of personalized diagnostic and therapeutic algorithms. Among the most promising areas are the development of targeted immunomodulatory agents, the use of exosomal preparations, and the creation of nanoengineered dental implant coatings capable of locally releasing bioactive molecules for the targeted regulation of the inflammatory response.