Contemporary Strategies for Regenerating Dehiscence and Fenestration Defects Around Dental Implants: A Critical Review.

Background: The long-term success of dental implants is intrinsically linked to the stability of surrounding peri-implant tissues. Dehiscence and fenestration defects represent significant clinical challenges that can compromise functional and aesthetic outcomes. This review provides a comprehensive analysis of modern strategies for managing these defects at implant sites. Methodology: We evaluate defect etiology and classification while underscoring the necessity of 3D diagnostic tools like Cone-Beam Computed Tomography (CBCT). The review critically examines Guided Bone Regeneration (GBR) components, comparing resorbable and non-resorbable membranes alongside various bone grafting materials. Additionally, we explore the roles of biologics, soft tissue management, and digital CAD/CAM workflows. Results: Analysis indicates that implants with corrected defects achieve survival rates comparable to those in pristine bone, reaching up to 97.2% for dehiscences over 10 years. Resorbable collagen membranes and slow-resorbing xenografts (DBBM) are the clinical standards for routine defects due to predictable volume maintenance. Biologics like PRF enhance graft handling, while rhBMP-2 provides potent osteoinduction for complex cases. Literature confirms that hard tissue regeneration must be paired with soft tissue augmentation-specifically connective tissue grafts to convert thin phenotypes into recession-resistant architecture. Conclusion: Successful regeneration requires a holistic approach combining biological principles, meticulous soft tissue management, and digital precision to ensure long-term stability.