Background <p>Oral rehabilitation using dental implants has become one of the most effective options for treating patients needing tooth replacement. However, there are complications such as lesions associated with dental implants which can lead to severe consequences. This study aims to evaluate the frequency and microscopic type of lesions related to dental implants.</p> Methods <p>This retrospective cross-sectional study included patients with documented lesions around dental implants referred to the Oral and Maxillofacial Pathology Department of Shahid Beheshti University of Medical Sciences between 2013 and 2024. Archived records were reviewed, and data on patient demographics, lesion location, and histopathological diagnosis were collected. Statistical analyses were conducted using SPSS20 employing chi-squared, fisher’s exact, One-way ANOVA, and independent samples T-test.</p> Results <p>Out of 3641 biopsies, 43 (1.18%) cases had lesions associated with dental implants. Their mean age was 54.93 ± 14.47 years, with a male-to-female ratio of 1.38. Based on histopathologic characteristics of the lesions, they were classified into four categories (1) inflammatory/reactive, (2) developmental cysts, (3) neoplastic, and (4) oral potentially malignant disorders. The most frequent lesions belong to the inflammatory/reactive group and include non-specific inflammation (peri-implantitis) (39.5%) and peripheral giant cell granuloma (14%). Oral squamous cell carcinoma was the most frequent malignancy around dental implants.</p> Conclusions <p>Various lesions have been observed around dental implants. Some of these lesions pose serious risks to the patient’s health, while others can be easily controlled if diagnosed promptly. It is highly recommended to analyze the peri-implant tissue histopathologically if the treatment option is surgical intervention.</p> Graphical abstract <p></p>