{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:13:46Z","timestamp":1788171226385,"version":"build-2803163510"},"reference-count":99,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Periodontology 2000"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Aim<\/jats:title>\n                    <jats:p>Peri\u2010implantitis is a plaque\u2010associated disease characterized by inflammation of the peri\u2010implant mucosa and progressive loss of supporting bone, representing a growing clinical and public health challenge. Conventional nonsurgical therapies often provide limited and unpredictable outcomes, while surgical approaches are associated with increased morbidity and variable long\u2010term success. In this context, minimally invasive strategies, particularly flapless submucosal instrumentation, have emerged as a potential alternative or adjunct in the management of peri\u2010implantitis. The aim of this narrative review is to critically appraise the contemporary evidence on flapless treatment approaches for peri\u2010implantitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This narrative review analyzes the available literature on flapless submucosal instrumentation for peri\u2010implantitis, presented as a minimally invasive access approach performed without flap elevation that combines submarginal instrumentation with deliberate peri\u2010implant degranulation\/curettage to improve access to the defect and implant surface, and may be considered in treatable, selected peri\u2010implantitis cases within a stepwise care pathway. The biological rationale for flapless therapy is discussed based on the histopathological characteristics of peri\u2010implant lesions, emphasizing the role of inflamed peri\u2010implant soft tissues as a persistent reservoir of infection. Current mechanical, chemical, and adjunctive modalities employed within flapless protocols are reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinical, radiographic, systemic, and patient\u2010reported outcomes associated with flapless treatment approaches are examined. In addition, indications, limitations, and prognostic factors\u2014including defect morphology, implant surface characteristics, prosthetic design, and patient\u2010related risk factors\u2014are analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although the available evidence remains heterogeneous and is largely derived from nonrandomized studies, flapless submucosal instrumentation appears to be a biologically sound and minimally invasive option for selected peri\u2010implantitis cases, which may be repeated when clinically indicated while acknowledging heterogeneous protocols and limited comparative evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Flapless submucosal instrumentation may reduce the need for more extensive surgical interventions. Practical clinical recommendations and step\u2010by\u2010step treatment algorithms are proposed to support evidence\u2010based and patient\u2010centered decision\u2010making in the management of peri\u2010implantitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/prd.70091","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:15:50Z","timestamp":1788167750000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flapless submucosal instrumentation treatment of peri\u2010implantitis: Contemporary evidence and clinical protocol"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2363-4992","authenticated-orcid":false,"given":"Jos\u00e9","family":"Nart","sequence":"first","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"},{"name":"Nart Dental Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neus","family":"Carri\u00f3","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2253-3927","authenticated-orcid":false,"given":"Gonzalo","family":"Blasi","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0826-8901","authenticated-orcid":false,"given":"Maria Costanza","family":"Soldini","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7472-7526","authenticated-orcid":false,"given":"Ramon","family":"Pons","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4128-6960","authenticated-orcid":false,"given":"Matteo","family":"Albertini","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5542-7659","authenticated-orcid":false,"given":"Beatriz","family":"de Tapia","sequence":"additional","affiliation":[{"name":"Department of Periodontology, School of Dentistry Universitat Internacional de Catalunya (UIC\u2010Barcelona)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12957"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12549"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.11607\/ijp.6883"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12334"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0501.2012.02541.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.24-0154"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13823"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12049"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0501.2012.02542.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.5037\/jomr.2016.7313"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ID.0000000000000846"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13762"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13749"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.11607\/jomi.7343"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12067"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13993"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13564"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-019-02943-8"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-023-04918-2"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13456"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.70024"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12460"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.25-0270"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.11607\/jomi.2014suppl.g5.3"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2008.01276.x"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.13162"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0026-4970.17.04054-7"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12689"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13969"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2017.170362"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2011.01820.x"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2008.01352.x"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12476"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1990.61.12.719"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.14339"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1235155"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13732"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12224"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13446"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.11607\/jomi.7409"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.22-0716"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0501.2011.02186.x"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0501.2011.02208.x"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-020-03681-y"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13464"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13914"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2009.01421.x"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13713"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12773"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12322"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.12747"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.12875"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12123"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.61872\/sdj-2014-07-08-04"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2017.160483"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0757.2010.00346.x"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0501.2001.012002104.x"},{"issue":"3","key":"e_1_2_11_59_1","first-page":"374","article-title":"Lethal photosensitization, autogenous bone, and e\u2010PTFE membrane for the treatment of peri\u2010implantitis: preliminary results","volume":"15","author":"Haas R","year":"2000","journal-title":"Int J Oral Maxillofac Implants"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/7692387"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2025.105680"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/00008505-199205000-00009"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.12130"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.02693"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0501.2003.01871.x"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12648"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034515610056"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.21-0103"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.12913"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-020-03578-w"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1556\/030.2020.01176"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1556\/030.2020.01080"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.14014"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2016.150684"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-023-03058-z"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13169"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.14153"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192315609"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12101965"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11121766"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05942-6"},{"issue":"1","key":"e_1_2_11_82_1","first-page":"11","article-title":"Successful management of peri\u2010implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3\u2010 to 7.5\u2010year follow\u2010up","volume":"32","author":"Froum SJ","year":"2012","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_11_83_1","doi-asserted-by":"publisher","DOI":"10.17116\/stomat202110006124"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05924-8"},{"key":"e_1_2_11_85_1","doi-asserted-by":"publisher","DOI":"10.3390\/pharmaceutics14081628"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1002\/cre2.286"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13821"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-30890-8"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-025-05680-5"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.12791"},{"key":"e_1_2_11_91_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0501.2006.01320.x"},{"key":"e_1_2_11_92_1","doi-asserted-by":"publisher","DOI":"10.11607\/prd.7205"},{"key":"e_1_2_11_93_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2010.01540.x"},{"key":"e_1_2_11_94_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.16-0350"},{"key":"e_1_2_11_95_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13790"},{"key":"e_1_2_11_96_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-022-04451-8"},{"key":"e_1_2_11_97_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13711"},{"key":"e_1_2_11_98_1","doi-asserted-by":"publisher","DOI":"10.1111\/idh.12442"},{"key":"e_1_2_11_99_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13789"},{"key":"e_1_2_11_100_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-017-0428-8"}],"container-title":["Periodontology 2000"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/prd.70091","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/prd.70091","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/prd.70091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:15:52Z","timestamp":1788167752000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/prd.70091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":99,"alternative-id":["10.1111\/prd.70091"],"URL":"https:\/\/doi.org\/10.1111\/prd.70091","archive":["Portico"],"relation":{},"ISSN":["0906-6713","1600-0757"],"issn-type":[{"value":"0906-6713","type":"print"},{"value":"1600-0757","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"assertion":[{"value":"2026-02-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"prd.70091"}}