Peri-implantitis, a common complication among patients receiving implant-supported restorative

therapy, often requires surgical intervention for effective treatment. Understanding the specific

configuration of peri-implant bony defect and adjacent bone peaks is crucial for tailoring treatment

strategies and improving outcomes. A decision tree for reconstructive peri-implantitis therapy has been

developed based on the new classification of defect configurations (Class I to V), guiding clinicians in

selecting treatment options, including biomaterials, techniques, and healing approaches. Furthermore,

clinicians are encouraged to consider various factors such as local predisposing factors (such as soft

tissue characteristics, prosthetic design, and implant position in three-dimensional perspective), clinical

factors (surgeon skill and experience), and patient-related factors (such as local and systemic health,

preferences, and cost) when evaluating reconstructive therapy options.