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The phenomenon of peri‐implantitis is a well‐recognized and frustrating clinical problem for dental implant surgeons and patients. Part of this frustration lies in the fact that unlike periodontal disease, which is well defined and organized into categories, peri‐implantitis remains a rather ambiguous and debated term with variable clinical presentation. Some surgeons prefer the term “peri‐implantosis” since there are instances where there is bone loss surrounding an implant, but an absence of inflammation, so the term “peri‐implantitis” would not technically apply [35]. Most surgeons agree that for a diagnosis of peri‐implantitis to exist the presence of gingival recession and implant exposure and bone loss should be present. The distinguishing factor between peri‐implantitis and peri‐implant mucositis is that peri‐implantitis has bone loss around the implant (Figure 3.16), while peri‐implant mucositis does not exhibit bone loss since the inflammation is confined to the mucosa (Table 3.5). The bone loss in peri‐implantitis has been referred to as a “saucer‐shaped” bone defect around the implant on clinical examination and a peri‐implant radiolucency on radiographic imaging (Figure 3.17). Peri‐implantitis often presents itself years after initial dental implant placement, and for this reason is included in the late‐stage infection category. Often, the peri‐implant bone loss is discovered incidentally on routine dental radiographs, and in the posterior region of the jaws, the presence of gingival inflammation, pain, BOP, purulence, and recession may go unrecognized by the patient for some time. Peri‐implantitis is believed to be due to biofilm formation on the implant surface with colonization by Staphylococcus aureus, which is an organism not typically seen with periodontitis. Risk factors include a history of periodontitis, smoking, poor oral hygiene, exposed implant threads, exposed surface coatings, and deep pocket depths. Treatment includes mechanical debridement with ultrasonic scalers or a titanium wire brush or the use of an erbium–YAG laser, implant surface decontamination with citric acid solution (5%), chlorhexidine irrigation, local antibiotics (25% tetracycline gel or fibers), systemic antibiotics (ornidazole or metronidazole), and improved oral hygiene that may be improved with an alteration in the prosthetic design (e.g., ridge‐lap prosthesis, or splinted prosthesis). Also, surgical reconstruction may include regenerative surgery with bone grafting, GBR, or connective tissue grafting, or resective surgery with osteoplasty and apically repositioned flaps. If there is retained cement in the area, it should be debrided. Of the options of debridement, resection, grafting, and GBR, bone grafting and GBR may have improved bone fill and pocket depth reduction in cases of peri‐implantitis.