The long-term success of dental implants depends critically on osseointegration and peri-implant tissue health. While local factors have been extensively investigated, the influence of systemic metabolic disorders—particularly hyperlipidemia—on implant outcomes remains insufficiently understood. Hyperlipidemia is among the most common metabolic diseases globally and is increasingly recognized for its adverse effects on bone metabolism, immune response, and microcirculation. However, its role in osseointegration, which is responsible for peri-implant bone healing and the development of peri-implant diseases, is still controversial and lacks systematic evaluation. Based on our summary of the latest literature, the process of osseointegration can be summarized as angiogenesis-mediated 5-phase osseointegration. The 5 phases refer to 1) hydration/protein adsorption, 2) platelet-mediated fibrin clot formation, 3) immune cell adhesion, 4) osteogenic–bacterial competitive adhesion, and 5) angiogenesis–osteogenesis coupling. Angiogenesis-mediated 5-phase osseointegration facilitates a dynamic perspective for understanding the physiological processes involved in osseointegration. This review comprehensively summarizes clinical and experimental studies on the relationship between hyperlipidemia and osseointegration. The analysis focuses on peri-implant bone healing and peri-implant disease development from the perspective of angiogenesis-mediated 5-phase osseointegration. To our knowledge, this review creatively integrates both clinical and experimental evidence regarding the impact of hyperlipidemia on peri-implant bone healing and complications.
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