Purpose <p>Peri-implantitis is a major biological complication in implant dentistry, associated with bacterial biofilm formation and amplified by dysregulated host immune responses. Increasing evidence indicates that implant and abutment surface properties influence not only osseointegration but also microbial retention, soft-tissue sealing, and innate immune cell behavior. This narrative review aimed to summarize the current evidence on how dental implant nanotopography may affect peri-implantitis-related biological responses, with particular emphasis on innate immunity, region-specific peri-implant biointerfaces, and peri-implant tissue stability.</p> Methods <p>Clinical, animal, and in vitro studies were reviewed to examine the pathogenesis of peri-implantitis, the roles of innate immune cells, the influence of implant and abutment surface topography on microbial and immune responses, and emerging nano-enabled strategies for the active regulation of peri-implant tissue responses.</p> Results <p>Peri-implantitis progression is shaped by the interplay among the disruption of transmucosal soft-tissue sealing, microbial invasion, implant- or abutment-derived foreign-body stimuli, and sustained dysregulated innate immune activation. Nanotopographic surfaces regulate epithelial and fibroblastic attachment, extracellular matrix organization, neutrophil and macrophage responses, and osteocyte network formation via mechanotransduction. The biological effects of nanotopography are design-dependent and are influenced by nanoscale geometry, size, hydrophilicity, and associated physicochemical properties, including surface chemistry, wettability, and charge. Additionally, anisotropic nanospike surfaces and nano-enabled biomolecule delivery technologies illustrate the future possibility of active nanointerface regulation beyond conventional surface modification, although intracellular delivery technologies currently remain conceptual for dental implant applications.</p> Conclusions <p>Implant and abutment nanotopography may contribute to peri-implant tissue stability by coordinating soft-tissue sealing, microbial retention control, innate immune calibration, and bone-interface resilience. Although direct clinical evidence remains limited, region-specific and functionally active nano-biointerfaces may offer new opportunities to reduce susceptibility to peri-implant inflammatory tissue breakdown.</p>