The article provides an overview of surgical treatment options for peri-implantitis, emphasizing the importance of decontaminating infected implant surfaces and reducing peri-implant pocket depth to ≤5 mm. Non-surgical approaches have shown limited effectiveness, leading to the consideration of surgical interventions. The primary surgical procedures include access flap debridement, which may be combined with resective techniques or implantoplasty, and reconstructive procedures aimed at regenerating bone defects and achieving re-osseointegration. Key points include: 1. **Indications for Surgical Management**: Surgical intervention is recommended when non-surgical methods fail to achieve adequate results. 2. **Access Flap Debridement**: This involves raising a mucoperiosteal flap to access and clean the infected implant surface. It can be combined with resective procedures or implantoplasty. 3. **Reconstructive Procedures**: These aim to restore lost peri-implant bone using bone substitutes and connective tissue grafts. The choice of materials and techniques can significantly impact outcomes. 4. **Clinical Outcomes**: Studies have shown mixed results, with some indicating improved clinical and radiographic outcomes following reconstructive procedures. However, the effectiveness varies based on factors such as defect severity, implant type, and patient-specific conditions. 5. **Ethical Considerations**: The authors declare no conflicts of interest and provide funding information. The article concludes that while non-surgical treatments are often the first step, surgical interventions are crucial for advanced cases. Adequate plaque control and minimally invasive approaches are essential for successful treatment.The article provides an overview of surgical treatment options for peri-implantitis, emphasizing the importance of decontaminating infected implant surfaces and reducing peri-implant pocket depth to ≤5 mm. Non-surgical approaches have shown limited effectiveness, leading to the consideration of surgical interventions. The primary surgical procedures include access flap debridement, which may be combined with resective techniques or implantoplasty, and reconstructive procedures aimed at regenerating bone defects and achieving re-osseointegration. Key points include: 1. **Indications for Surgical Management**: Surgical intervention is recommended when non-surgical methods fail to achieve adequate results. 2. **Access Flap Debridement**: This involves raising a mucoperiosteal flap to access and clean the infected implant surface. It can be combined with resective procedures or implantoplasty. 3. **Reconstructive Procedures**: These aim to restore lost peri-implant bone using bone substitutes and connective tissue grafts. The choice of materials and techniques can significantly impact outcomes. 4. **Clinical Outcomes**: Studies have shown mixed results, with some indicating improved clinical and radiographic outcomes following reconstructive procedures. However, the effectiveness varies based on factors such as defect severity, implant type, and patient-specific conditions. 5. **Ethical Considerations**: The authors declare no conflicts of interest and provide funding information. The article concludes that while non-surgical treatments are often the first step, surgical interventions are crucial for advanced cases. Adequate plaque control and minimally invasive approaches are essential for successful treatment.