Human herpesviruses in peri-implantitis pathogenesis: a narrative review of clinical evidence

Background. Human herpesviruses are frequently detected in peri-implantitis; however, it remains unclear whether viral detection reflects passive carriage in inflamed niches or contributes to disease initiation and/or progression. Objectives. To assess the clinical evidence on the involvement of EBV, CMV, and HSV in the pathogenesis of peri-implantitis, with a focus on methodological heterogeneity, including case definitions, sampling methods, and PCR techniques, as well as on reported associations that may support a causal or cofactor role. Materials and methods. PubMed/MEDLINE, Web of Science, and Google Scholar were searched for for relevant literature up to March 30, 2026. Reviews, cross-sectional studies, case-control studies, and observational studies assessing the presence of herpesviruses in peri-implantitis, peri-implant health, and peri-implant mucositis were included. Results. Epstein-Barr virus (EBV) showed the strongest, although inconsistent, association with peri-implantitis, whereas evidence regarding cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1) involvement was limited. Substantial heterogeneity was identified in case definitions, specimen sources, detection methods, and confounder control, limiting comparability across studies. Conclusions. Current evidence does not establish herpesviruses as independent primary causes of peri-implantitis but supports further investigation of a potential viral-bacterial cofactor model in established lesions.