Scientists engineer biomaterials to regenerate periodontal bone

Periodontal disease affects the gums, jawbone and the connective tissues that hold teeth in place. When the disease isn’t treated early, infection and inflammation can result in tooth loss, severely affecting quality of life.

Inadequate dental care is one of the most overlooked health crises worldwide. Nearly half of the world’s population suffers from at least one oral disease, and nearly 1 billion are diagnosed with periodontal disease, with incidence rates continuing to rise.

Periodontal disease is caused by accumulating dental plaque, a sticky layer of bacteria that hardens into tartar if left unremoved. This layer of bacteria causes redness and inflammation of the gums in the early stage of periodontal disease (gingivitis) and progresses into more chronic inflammation as the plaque moves below the gumline in advanced stages of periodontitis, permanently destroying jawbone and connective tissue.

Ideally, adequate dental care would prevent the tooth and tissue loss observed in periodontal disease, but this isn’t the case today. Currently, researchers are focusing on understanding the immune system’s response (immunomodulation) in periodontal disease not only to halt the progression of the disease but also to regenerate lost bone and other tissues as a result of advanced periodontitis. A group of scientists from Wuhan University recently completed a comprehensive review of the current mechanisms, regenerative biomaterials and remaining hurdles for oral tissue regeneration in their paper “Advances in osteoimmunomodulatory biomaterials for periodontal bone regeneration,” published in the journal Oral Science and Homeostatic Medicine on September 22 by Tsinghua University Press.

“Guided tissue regeneration (GTR) is a periodontal regenerative technique that utilizes barrier membranes to selectively exclude undesirable cell populations and create a favorable environment for the regeneration of periodontal tissues. Periodontal regenerative materials, including barrier membranes, bone graft substitutes and biologically active agents, can be applied alone or in combination tolimit tissue damage, maintain tooth spacing and promote new tissue formation,” said Yufeng Zhang, professor in the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration at Wuhan University and senior author of the research study.

Barrier membranes are designed to exclude undesired soft tissue cells from the regenerative site, thereby creating a favourable environment for the regeneration of the target tissues. Bone graft substitutes are materials used as an alternative to the patient’s own bone to provide a scaffold for new bone to regenerate. Biologically active agents are proteins or compounds that can be used alone or in conjunction with barrier membranes or bone graft substitutes to promote bone growth. Current research is designed to improve the functionality of these materials based on an enhanced understanding of the constant interplay between the immune system and any biomaterials used to regenerate lost tissue.

“It has become increasingly recognized that the implantation of biomaterials inevitably elicits host immune responses, which largely dictate the trajectory of the local regenerative microenvironment and ultimately influence tissue healing. Thus, systematically understanding the interaction between biomaterials and immunity, and integrating immune regulation strategies into the rational design of periodontal regeneration materials, has become a core and enduring research focus in this field,” said Zhang.

Researchers have found that physical properties of biomaterials directly regulate immune cell activity, and altering surface topography, roughness, nanoscale structure, pore architecture, material stiffness, surface hydrophilicity and surface charge can alter the periodontal

immune microenvironment. Experiments have also established that chemicals, and metal ion release during material degradation in particular, can also change the immune microenvironment. Biomaterials can also successfully deliver biomolecules and cells to a specific site, and stimuli-responsive materials can convert cues into signals, further regulating the

local immune microenvironment and regenerative process.

Despite all of the available means to foster bone regeneration in periodontal disease, significant challenges remain. “In contrast to other bone defect models, periodontal tissues are continuously exposed to a diverse oral microbiota and their metabolic byproducts, resulting in a highly dynamic local immune landscape characterized by persistent activation and recurrent fluctuations,” said Zhang.

The field also lacks relevant animal models to test new biomaterials and their long-term safety, limiting the translation of these materials to clinical use in humans. As new biomaterials evolve to modulate several immune cell populations at a single time, researchers hope to develop new techniques that will provide more precise, stable and durable bone regeneration for periodontal disease patients.

Tiange Zhang, Shanyi Yang and Yifan Niu from the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration in the Key Laboratory of Oral Biomedicine Ministry of Education at the Hubei Key Laboratory of Stomatology in the School & Hospital of Stomatology at Wuhan University in Wuhan, China; and Mingyu Tang, Yu Cui, Qi Xiao, Mingyue Su, Mengqi Gao and Yulan Wang from the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration in the Key Laboratory of Oral Biomedicine Ministry of Education at the Hubei Key Laboratory of Stomatology and the Department of Oral Implantology in the School & Hospital of Stomatology at Wuhan University also contributed to this research.

DOI Link:

https://doi.org/10.26599/OSHM.2026.9610072