The article discusses the surgical treatment of peri-implantitis, a condition affecting the tissues around dental implants. It outlines various treatment options, emphasizing the importance of decontaminating the implant surface and reducing pocket depth to ≤5 mm. Non-surgical approaches have shown limited effectiveness, prompting the need for surgical interventions. Surgical treatments include access flap debridement, which involves removing inflammatory tissue and decontaminating the implant surface. This procedure may lead to post-operative recession of the mucosal margin. Reconstructive procedures aim to regenerate bone and restore soft tissue, often using bone substitutes. Indications for surgical management include cases where non-surgical methods have failed, and where there is significant bone loss. Access flap debridement without resective procedures has shown favorable outcomes, though long-term success varies. When combined with resective techniques or implantoplasty, it can improve results. Reconstructive approaches, such as using deproteinized bovine bone mineral with 10% collagen, have shown promise in restoring bone and soft tissue. The article highlights the importance of patient factors, such as low plaque and bleeding scores, and site factors like defect depth and configuration. It also discusses the role of implant surface type and the need for careful flap design to minimize trauma and ensure successful outcomes. While some biomaterials show effectiveness, there is no clear hierarchy of efficacy among them. The use of a barrier membrane can sometimes increase the risk of complications. The study emphasizes the need for a dual approach combining mechanical and chemical decontamination before evaluating bone defects. Reconstructive surgery is recommended for severe cases, though it is not always superior to access flap surgery. The article concludes that peri-implantitis treatment requires a combination of decontamination, reconstructive procedures, and long-term maintenance to ensure successful outcomes. The role of flap design and minimally invasive techniques is crucial in achieving optimal results.The article discusses the surgical treatment of peri-implantitis, a condition affecting the tissues around dental implants. It outlines various treatment options, emphasizing the importance of decontaminating the implant surface and reducing pocket depth to ≤5 mm. Non-surgical approaches have shown limited effectiveness, prompting the need for surgical interventions. Surgical treatments include access flap debridement, which involves removing inflammatory tissue and decontaminating the implant surface. This procedure may lead to post-operative recession of the mucosal margin. Reconstructive procedures aim to regenerate bone and restore soft tissue, often using bone substitutes. Indications for surgical management include cases where non-surgical methods have failed, and where there is significant bone loss. Access flap debridement without resective procedures has shown favorable outcomes, though long-term success varies. When combined with resective techniques or implantoplasty, it can improve results. Reconstructive approaches, such as using deproteinized bovine bone mineral with 10% collagen, have shown promise in restoring bone and soft tissue. The article highlights the importance of patient factors, such as low plaque and bleeding scores, and site factors like defect depth and configuration. It also discusses the role of implant surface type and the need for careful flap design to minimize trauma and ensure successful outcomes. While some biomaterials show effectiveness, there is no clear hierarchy of efficacy among them. The use of a barrier membrane can sometimes increase the risk of complications. The study emphasizes the need for a dual approach combining mechanical and chemical decontamination before evaluating bone defects. Reconstructive surgery is recommended for severe cases, though it is not always superior to access flap surgery. The article concludes that peri-implantitis treatment requires a combination of decontamination, reconstructive procedures, and long-term maintenance to ensure successful outcomes. The role of flap design and minimally invasive techniques is crucial in achieving optimal results.