Peri-implantitis is characterized by inflammation of peri-implant soft tissues and progressive loss of supporting bone that is often circumferential in nature (Figure 2).51,52 Histologically, peri-implant lesions with similar clinical characteristics often have larger inflammatory lesions than periodontitis lesions around teeth.53 At an implant presenting with clinical signs of inflammation and radiographic bone loss, systemic, oral and local risk factors should be assessed to determine all possible underlying etiologic factors. Initial therapy should include elimination of the etiologic factors to ensure success of reparative treatment, if necessary. Establishing ideal overall health, plaque control, and compliance with professional maintenance is critical to the long-term success of therapy. Once it is established that it is possible for the patient to maintain good oral health, site-specific assessment should be performed.to determine if defects can be repaired. Additionally, assessment of the best treatment option for the individual patient and site should be undertaken. This assessment should include an evaluation of the implant and/or prosthetic component mobility, peri-implant defect dimensions, and condition of the implant should be undertaken to allow for optimal customization of the treatment protocol.