Peri-implant disease is a prevalent and serious complication that seriously affects the implant effect. It is characterized by inflammation around the implant, which may lead to bone loss and ultimately affect the stability of the implant. The pathogenesis of peri-implant disease is complex, involving multiple interactions between bacterial factors and the host immune response, which has attracted much attention for a long time. Macrophage is a type of immune cells that play an important role in phagocytosis and foreign substances removal. Studies have shown that differences in their expression and activation in peri-implant tissues may determine the inflammatory environment and affect the regression of inflammation and the progression of peri-implant disease. Based on this, this article reviews the research on the expression of macrophage polarization in peri-implant disease, molecular mechanism and its application in the repair of hard and soft tissue defects.