Dental implants are now considered the treatment option for missing teeth. They hold a high survival rate with great patient satisfaction. In the last 3 decades, new infectious diseases emerged around dental implants, termed peri-implant mucositits and peri-implantitis. These infectious diseases comprise similar characteristics to periodontitis, including soft and hard tissue loss. The etiology of peri-implant disease is many, one of them is the alteration of the peri-implant microbiome. In health, implants comprise mainly of facultative anaerobic gram-positive cocci, in which the microbiome resides in a symbiotic state where all microorganisms co-exist with each other. On the other hand, diseased implants include gram-negative anaerobic rods and spirochetes, in which the microbiome resides in a dysbiotic state, where disease-associated species and the metabolic activity is increased. This microbial shift occurs due to many reasons such as the presence of periodontitis history, adjacent diseased natural teeth, and implants placed in periodontally affected subjects. Candidate individuals with a strict supportive periodontal care along with controlled local and systemic factors, that negatively affect the microbiome, is mandatory to maintain the symbiotic state around dental implants.