Oral peri-implant tissue as a neoplastic bed: a systematic review of clinicopathology, pathogenesis, and survival outcomes

Background Peri-implant neoplasia (PIN) is a descriptive term introduced in this review to categorize neoplasms present adjacent to dental implants. Understanding its clinicopathological spectrum and pathogenesis is essential for timely diagnosis and management.Objective This systematic review evaluated evidence on the clinicopathological features, risk factors, pathogenetic mechanisms, and survival outcomes of peri-implant neoplasia.Methods Following PRISMA guidelines (PROSPERO ID: CRD42024586140), a systematic search of PubMed, Embase, Scopus, and Web of Science identified studies published until December 2025. Eligible studies included case reports, case series, and cross-sectional studies with histopathologically confirmed peri-implant neoplasia. Extracted data included demographics, clinical presentation, risk factors, histopathology, treatment, and outcomes. Risk of bias was assessed using Joanna Briggs Institute checklists, and pooled survival analysis was performed using Kaplan-Meier curves.Results Fifty-six studies involving 187 patients were included. Malignant epithelial neoplasms accounted for 92.3% of lesions, with oral squamous cell carcinoma predominating. The mean patient age was 66.3 years, with a slight female predominance. The mandible was the most common implant and lesion site, and most cases occurred within 1-5 years post-implantation. Clinical misdiagnosis as peri-implantitis occurred in 54% of cases. Factors associated with recurrence or death included prior OPMD/malignancy, radiographic bone loss, and treatment modality. Kaplan-Meier analysis showed mean survival time of 64.1 months (95% CI: 46.8-81.4), with poorer outcomes for sarcoma and metastasis.Conclusions Peri-implant neoplasia is predominantly malignant and often mimics peri-implantitis. Clinicians should promptly biopsy non-healing peri-implant lesions and ensure close surveillance in high-risk patients.