Peri-implantitis and peri‑implant oral malignancies: A systematic review and meta-analysis of diagnostic challenges and potential associations

Objective: This systematic review and meta-analysis aimed to investigate the potential association between peri‑implantitis (PI) and peri‑implant oral malignancies (PIOM). Data and Sources: Systematic searches were conducted in Medline (PubMed), Embase, CENTRAL, and Web of Science up to December 10, 2024. Gray literature and reference lists were also searched. The protocol was registered in PROSPERO (CRD42024622566). Data synthesis involved descriptive analyses, Kaplan–Meier survival estimates, and a meta-analysis of proportion. Study Selection: Studies were eligible if they reported PIOM cases. Animal studies, in vitro studies, reviews, and conference proceedings were excluded. A meta-analysis included retrospective studies reporting more than five PIOM cases. Inter-investigator reliability was assessed using Cohen's kappa statistic. Conclusions: Fifty-seven studies (51 case reports/case series, 6 retrospective studies) involving 161 patients were included. Although the current evidence, limited to retrospective analyses and case reports, was insufficient to establish a definitive link, this review synthesized available data to provide preliminary insights and highlight directions for future research. The meta-analysis revealed that 50 % of PIOM cases were initially misdiagnosed as PI, with squamous cell carcinoma being the most common final diagnosis (81 % in case reports and 97 % in retrospective studies). The median time from implant placement to PIOM diagnosis was 5 years, irrespective of traditional risk factors such as smoking, alcohol consumption, or previous cancer history. Although the evidence suggests a potential link between chronic peri‑implant inflammation and malignant transformation, the limited nature of the available data highlights the need for prospective studies to establish causality and improve diagnostic protocols. Clinical significance: PIOM can mimic peri‑implantitis, leading to misdiagnosis and delayed treatment. Clinicians should maintain a high index of suspicion for malignancy in persistent peri‑implant lesions unresponsive to conventional therapy, emphasizing the need for timely biopsy and histopathological evaluation, even in patients without traditional risk factors.