The Salivary Healing Signature: From Disease Detection to Prediction and Monitoring of Periodontal and Peri-Implant Tissue Healing

Periodontal and peri-implant diseases cause progressive tissue destruction that may lead to tooth and implant loss. Conventional clinical and radiographic assessments document accumulated tissue damage but provide limited information on current biological activity or healing. This narrative review synthesizes the literature published between 2015 and 2025, identified through searches of PubMed/MEDLINE, Scopus, and Web of Science, on salivary biomarkers in periodontal and peri-implant diseases, with emphasis on diagnostic performance, changes after therapy, and clinical translation. Salivary inflammatory mediators and tissue- and bone-remodeling markers—including interleukin (IL)-1β, IL-6, IL-8, IL-17, tumor necrosis factor-α, matrix metalloproteinase (MMP)-8, MMP-9, calprotectin, and the RANKL/osteoprotegerin axis—are consistently associated with periodontal and peri-implant disease. Multimarker panels generally outperform single biomarkers, with some studies reporting areas under the curve above 0.90 for periodontitis detection; however, most evidence derives from cross-sectional diagnostic studies, and prospective prognostic data remain limited. We propose the “salivary healing signature” as a conceptual framework—not a validated test—in which serial multimarker measurements could complement clinical assessment for disease detection, risk stratification, and treatment monitoring. Standardized sampling and analytical protocols, control of confounders, defined thresholds, and prospective validation in diverse populations are required before clinical implementation.