Enhancement of Soft and Hard Tissue Structures Through Bone Regenerative Therapies in Periodontal Disease: A Comprehensive Review

Chronic periodontitis is a complex inflammatory condition that leads to the gradual deterioration of periodontal tissues, such as the gingiva, periodontal ligament, and alveolar bone. The disease pathogenesis involves complex interactions between microbial, host, genetic, and environmental factors, with subgingival biofilms playing a key role. Host modulation therapies (HMTs), including local drug delivery (LDD) systems, have emerged as promising adjunctive treatments. Alendronate, statins, and metformin, when delivered locally, have shown potential in enhancing periodontal regeneration, reducing inflammation, and preventing bone loss. Alendronate inhibits osteoclast activity, promoting bone preservation and improving graft integration. Statins exert antimicrobial, antiinflammatory, and osteogenic effects, enhancing clinical attachment levels and reducing bone resorption. Metformin, through activation of AMPK, improves bone formation, reduces oxidative stress, and accelerates healing, particularly in diabetic conditions. Several studies have demonstrated the efficacy of these agents, with notable enhancement in radiographic defect fill, clinical attachment level, and probing depth. These findings highlight the potential of LDD systems in advancing periodontal disease management.