Abstract
BACKGROUND: Peri-implantitis is a biofilm-driven inflammatory condition that often requires surgical intervention. This case series aimed to evaluate the clinical outcomes of implantoplasty guided by a biofluorescence imaging system (BIS) in the surgical treatment of peri-implantitis. METHODS: Seven patients (13 implants) with peri-implantitis underwent BIS-guided flap surgery and selective implantoplasty. Probing depth (PD) and bleeding on probing (BOP) were assessed at baseline, and at 1, 3, and 6 months postoperatively, as well as at the final follow-up. Nonparametric statistical analyses were used to evaluate longitudinal changes across time points. RESULTS: A total of 7 patients (3 males and 4 females; mean age 71.9 ± 10.0 years) with 13 implants diagnosed with peri‑implantitis were included. The mean follow‑up period was 9.9 ± 2.7 months. The mean PD significantly decreased from 6.8 ± 1.5 mm at baseline to 3.0 ± 1.4 mm at the final follow‑up (p < 0.001), and BOP was completely resolved in all implants. All implants remained clinically stable, with no complications or recurrence. CONCLUSIONS: BIS enabled the accurate identification of mature biofilm and facilitated site‑specific, conservative decontamination. This selective approach, which targets infected surfaces while preserving implant structure, may be clinically advantageous for peri‑implantitis management. Further randomized controlled trials are warranted to validate these findings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-025-07644-1.