Emerging, personalized, and minimally invasive technologies for periodontal and peri-implant soft and hard tissue...

Regenerative therapies have become central to periodontics and implant dentistry and are becoming more widely applied to reconstruct supporting bone and associated soft tissues. With increased recognition of the benefits of using biomimetic materials as scaffolds in contemporary regenerative technologies, the field is seeking to develop and optimize predictable, personalized regenerative strategies for hard and soft tissue reconstruction. This review aims to: (1) evaluate the current evidence on these approaches in the context of hard and soft tissue deficiencies around teeth and implants, (2) assess the clinical utility of these approaches, and (3) propose a framework for integrating these regenerative technologies into daily clinical practice.

Applicable research on the treatment of hard and /or soft tissue deficiencies around teeth and dental implants were conducted. For soft tissue regeneration, data from eligible randomized clinical trials (RCTs) reporting the outcomes of gingival (for teeth, as gingival thickness [GT]) and mucosal thickness (implants, MT) with a bilaminar approach were analyzed using a mixed models network meta-analysis. A meta-analysis could not be performed to evaluate personalized, emerging technologies for bone regeneration given the lack of comparable clinical studies and as such, an alternative evaluative approach was undertaken and involved a qualitative assessment of the relevant literature highlighting innovations in these emerging modalities.

A total of 78 RCTs were included for a quantitative analysis on soft tissue regeneration. Fifty-four reported the outcomes of GT with a bilaminar approach (a total of 2952 teeth), and 24 assessed MT around implants (851 implants). The analysis of GT for natural dentition showed that bilaminar approaches with any of the explored soft tissue grafts (connective tissue graft (CTG), human acellular dermal matrix (hADM), first generation collagen matrix (CMX), "volume stable" collagen matrix (VCMX) yield a statistically significant increase in GT (compared with untreated sites), with the highest estimate for CTG, followed by VCMX, hADM, pADM, and CMX. Similarly, the analysis of MT around implants also showed a significant increase for all the investigated treatment groups, compared with untreated sites. No other significant differences were noted among the other treatment groups of (VCMX, hADM, and pADM). For the qualitative assessment of emerging technologies for bone regeneration, early investigational studies have been conducted evaluating the use of computer aided personalized scaffold design and manufacturing, stem cell transplantation, stem cell secretome delivery, and artificial intelligence. To date, there are limited controlled studies evaluating these approaches but the results of studies which have been conducted demonstrate safety, efficacy, and favorable patient-reported outcomes. Clinical translation of these emerging, personalized technologies for hard tissue regeneration will largely depend upon feasibility and cost effectiveness.

For the treatment of dento-alveolar deficiencies within the hard or soft tissue structures around teeth and implants, we found that autogenous soft tissue grafts as well as soft tissue grafting substitutes are generally effective to yield a significant increase in the soft tissue thickness of the treated sites. In the regeneration of hard tissue, emerging, personalized strategies have demonstrated promising early outcomes, yet additional longitudinal, controlled studies are required before these modalities can be considered for widespread clinical adoption.

Dentists and researchers are looking to find new ways to help the gums and bone around teeth and dental implants heal and grow back. In this review, we looked at 78 studies that tested different methods for improving gum tissue thickness as well as rebuilding the bone that supports teeth and implants. We found that using a patient's own gum tissue is still the most effective way to thicken and strengthen the gums. However, newer materials made from collagen or donated tissue can work almost as well and are easier for patients because they do not require tissue to be taken from the mouth. Around dental implants, all of these options helped increase gum tissue thickness, which may lower the risk of future disease and improve the look and long-term success of treatment. For rebuilding bone, early research on stem cells, 3D-printed materials, and products that help the body to heal on its own looks very promising, but larger studies are needed to confirm the results. Overall, this research shows that regenerative dentistry is moving toward more comfortable, less invasive, and more personalized treatments that can improve healing, appearance, and long-term stability.