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Beyond the Implant: Towards a Predictive, Preventive, Personalized and Participatory Approach to Patient-Centered Implant Dentistry—A Narrative Review

Year: 2026

Type: review

Abstract: Contemporary implant dentistry achieves remarkable survival rates, yet the rising prevalence of peri-implantitis and increasing patient complexity reveal the limits of a technically centered model. This narrative review synthesizes current evidence supporting the four pillars of the 4P framework-predictive, preventive, personalized, and participatory-and proposes an integrated patient-centered clinical algorithm for implant dentistry. Throughout this review, "4P" is used as the preferred designation; "P4 medicine" appears only in direct citation of original systems-medicine sources. A narrative literature search was conducted in PubMed, Scopus, and the Cochrane Library (January 2000 to June 2026). Reporting followed Scale for the Assessment of Narrative Review Articles (SANRA) Predictive tools-resonance frequency analysis, genomic biomarkers [investigational], artificial intelligence algorithms, and radiomic analysis-contribute to individual risk stratification, with variable levels of clinical validation. Preventive strategies anchored in a four-level continuum are associated with a peri-implantitis frequency of 18% in maintenance-compliant patients versus 43.9% in non-compliant patients, illustrating the measurable clinical impact of the preventive pillar. Personalized approaches optimize osseointegration according to each patient's biological profile. Participatory implantology, through shared decision-making and patient-reported outcome measures, improves the therapeutic alliance and long-term adherence. The 4P model constitutes a coherent and clinically applicable conceptual framework. Its novel contribution is a sequential decision-making logic distinguishing pre-placement gate-keeping from post-placement dynamic pillar reorientation, providing clinicians with a structured conceptual framework applicable at each phase of implant treatment.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm15207795

Authors: Pascal Valentini, Raphaelle Contencin, Giancarlo Bianca, Laura Constantini

Language: English

Topic: Dental Implant Techniques and Outcomes

Subfield: Oral Surgery

Field: Dentistry

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,137

Funder: Università di Corsica Pasquale Paoli