The paper “Perimplantitis-like MRONJ: clinical considerations and histological evaluation with confocal laser scanning microscope” is a nice work investigating clinical, radiological, and histological features of peri-implant MRONJ (PI-MRONJ). In particular, the authors reported a series of 19 osteoporotic patients undergoing antiresorptive drugs with a previous diagnosis of perimplantitis affected by PI-MRONJ. The results are interesting, suggesting that perimplantitis not healed after conventional therapy in patients at risk on MRONJ occurrence should be considered as perimplantits-like PI-MRONJ, and treated as required.
The reported clinical data are accurate and complete and clearly synthesized. The amount of photographic, radiographic, and histological data is adequate. Moreover, the authors conducted a comprehensive literature review on this topic.
Overall, I think the paper is interesting. However, I suggest few comments about this study:

Introduction: The Introduction section is too long. I suggest shortening this section, in particular the detailed discussion about the definition of perimplantitis.

Results: delete the percentages (if n < 100, the use of percentage implies a spurious impression of accuracy).
Delete the references “(Favia et al., 2011; Favia, Pilolli, & Maiorano, 2009)” in this section, or move them to Discussion.

Minor:
Please add “3)” in the description of patterns of bone involvement in PI-MRONJ (page 5 and page 10).
Introduce the extended name of the acronyms “BPs” (page 9).
Few minor language corrections should be necessary.

The authors made several changes, improving the quality of the manuscript.