Clinical context and challenges of regeneration

With a reported prevalence now reaching 19.83%, peri-implantitis stands as a major inflammatory complication threatening the longevity of implant rehabilitations. This condition, characterised by progressive bone loss, is driving the scientific community to seek therapeutic strategies capable of restoring the supporting tissues. Among the available options, regenerative therapy is attracting growing interest for its potential in bone and mucosal restoration.

However, the practitioner faces genuine technical complexity: although these procedures improve clinical and radiographic parameters, the superiority of a specific material or membrane remains to be demonstrated in the long term. Furthermore, achieving complete and predictable regeneration remains a constant challenge, marked by risks of complications such as membrane exposure.

Objectives and approach of the study

This study aims to conduct a comprehensive bibliometric analysis over a 30-year period to map the evolution of research on regenerative therapies applied to peri-implantitis. Unlike conventional systematic reviews, this method adopts a macroscopic perspective to quantitatively assess publication trends.

The analysis specifically aims to identify the most influential authors, institutions and journals, while modelling collaboration networks and emerging themes. By synthesising three decades of scientific data, the authors aspire to provide an integrated vision of the field and to highlight the future research directions essential for stabilising clinical protocols.

Methodology of the bibliometric analysis

To map the evolution of regenerative therapies applied to peri-implantitis, the authors implemented a quantitative bibliometric analysis covering a period of 30 years. Unlike systematic reviews focused on clinical outcomes, this computer-assisted methodology aims to provide a macroscopic perspective of research dynamics over three decades.

The data processing protocol relies on two specific software tools:

• OpenRefine: used for the rigorous processing and cleaning of raw bibliographic data to ensure the consistency of the extracted information.
• VOSviewer: used for the visualisation of scientific networks, the mapping of research clusters and the identification of emerging themes.

The analysis focused on several performance and influence indicators, including:

• The chronological volume of publications and growth trends.
• The identification of the most influential authors, institutions and countries in the field.
• The impact of specialised scientific journals.
• The structuring of collaborative networks and the detection of thematic research centres.

This quantitative approach provides an overview of the structural developments in research without being limited to an isolated analysis of clinical protocols.

Results of the research landscape analysis (1996-2026)

The review of data over three decades highlights a prevalence of peri-implantitis reaching 19.83%, confirming the magnitude of this inflammatory complication in global implant practice. The analysis of scientific output reveals a major geographical concentration, with the most influential studies originating primarily from Europe and North America.

Therapeutic trends and clinical efficacy

The study identifies significant developments in regenerative treatment modalities. The compiled data show that these interventions result in a systematic improvement in clinical and radiographic parameters compared to baseline. Key observations include:

• Probing pocket depth (PPD) reduction: Consistent improvement reported in regenerative protocols.
• Tissue regeneration: Gain in bone growth and improved health of peri-implant soft tissues.
• Reference modality: Guided bone regeneration (GBR) is identified as the central approach for the management of peri-implant defects (Mordini et al., 2021).

Identified limitations and complications

Despite the observed clinical benefits, the analysis highlights two critical points for practice:

The study concludes that while regenerative therapy is a valuable modality, the lack of standardised protocols and evidence of superiority for a specific material requires a cautious clinical approach adapted on a case-by-case basis.

The clinical challenge of regeneration

This bibliometric analysis places peri-implantitis back at the centre of concerns with a documented prevalence of 19.83%. The study highlights that, although regenerative techniques aim to restore lost peri-implant tissues, current data indicate that no long-term superiority of a specific material or membrane has yet been established. The complexity of managing peri-implant defects remains a major challenge for modern implantology.

Limitations and critical vigilance

A crucial point of caution: this publication displays a peer review status of '1 not approved', which necessitates a cautious interpretation of the data. The bibliometric approach, although useful for identifying the influence of institutions (primarily European and North American), offers a macroscopic view that confirms the difficulty of achieving complete and predictable regeneration chairside. Complications, notably membrane exposure, remain documented obstacles within the analysed corpus.

Implications for the practitioner

The substantial growth of the literature reflects a genuine improvement in clinical outcomes (reduction in probing depth, bone gain), but the lack of a universal 'gold standard' persists. For the clinician, this means that therapeutic success depends more on a rigorous selection of indications and precise tissue management than on the exclusive choice of a specific technological material.

Synthesis of three decades of data

This 30-year bibliometric analysis highlights the surge in scientific interest in peri-implantitis, the prevalence of which now reaches 19.83%. Although guided bone regeneration (GBR) has established itself as the primary approach to restore tissues, results over three decades confirm that no material (grafts, membranes or biological agents) has yet demonstrated absolute clinical or radiographic superiority in the long term.

In practical terms, for the practitioner:

• Freedom of material choice: The absence of a scientifically superior "gold standard" protocol allows you to favour materials (membranes and substitutes) whose clinical handling you have fully mastered, without the fear of falling short of current data.
• Focus on GBR: For intrabony defects, guided bone regeneration remains the most reliable strategy to reduce probing depth and stabilise bone levels, despite persistent complications such as membrane exposure.
• Managing expectations: Although regenerative techniques significantly improve parameters compared to baseline, complete and predictable regeneration is not yet a standardised reality in clinical practice.

Technical glossary of the study

Peri-implantitis: Inflammatory condition affecting the tissues surrounding dental implants, characterised by progressive bone loss that can lead to implant failure.

Bibliometric analysis: Computer-assisted scientific review methodology using statistical calculations to quantitatively evaluate publication trends and map research networks.

VOSviewer: Visualisation software tool used in this study to structure author networks, institutional collaborations and thematic clusters.

OpenRefine: Software used for cleaning and structuring raw scientific data to enable rigorous bibliometric analysis.

Barrier membranes: Devices used in regenerative therapies to restore lost tissues, although the study highlights that no specific material has yet demonstrated absolute superiority in the long term.

Radiographic and clinical outcomes: Measurement parameters (including bone growth and soft tissue health) used to evaluate the efficacy of treatment protocols for peri-implantitis.

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