Clinical efficacy of bioactive glass in periodontal regeneration: a systematic review and meta-analysis

Periodontal disease leads to progressive destruction of tooth-supporting tissues. Conventional therapies, such as open flap debridement, control inflammation but provide limited regeneration. Bioactive glass (BG), a bioactive and osteoconductive material, has emerged as a promising regenerative agent in periodontal therapy. This meta-analysis evaluated the clinical efficacy of BG in reducing probing depth (PD) and improving clinical attachment level (CAL) in periodontal lesions. A systematic search of Embase, PubMed, and Cochrane Library up to April 2025 identified randomized controlled trials (RCTs) assessing BG as a standalone intervention for periodontal regeneration. Studies reporting PD and/or CAL outcomes were included. Following Cochrane Collaboration standards, two reviewers independently extracted data and assessed bias risk. Meta-analysis using a random-effects model in RevMan (v5.4) addressed study heterogeneity. Twelve RCTs involving 234 patients and 406 periodontal defects were included. BG significantly improved PD reduction (MD = 1.27 mm; p = 0.0006) and CAL gain (MD = 1.49 mm; p = 0.0005), with moderate-to-high heterogeneity and no significant publication bias. These findings confirm that BG significantly enhances clinical outcomes in periodontal regeneration. Despite variability among studies, BG demonstrates strong potential as an effective regenerative material, warranting further high-quality trials.