Role of Adjunctive Biologic Agents in Scaffold-based Periodontal Regeneration: A Systematic Review

Review ARticleexplored for their mechanical stability, biodegradability, and biocompatibility. [6][7]][8][9] However, increasing evidence demonstrates that scaffolds, when used alone, have limited regenerative capability because they serve primarily as passive structural matrices. 9Their capacity to promote regeneration largely depends on the accompanying biological environment, defective vascularity, and host response. IntroductIonPeriodontitis is a chronic inflammatory disease characterized by progressive destruction of the periodontal ligament, cementum, and alveolar bone, ultimately resulting in pocket formation, tooth mobility, and tooth loss if left untreated. 1Its high global prevalence and documented associations with systemic diseases such as diabetes, cardiovascular conditions, and adverse pregnancy outcomes highlight the importance of predictable periodontal regenerative therapy. 2 Conventional nonsurgical therapy and open flap debridement effectively reduce bacterial load but primarily result in repair rather than true regeneration of the lost periodontal apparatus. 3rue regeneration requires coordinated formation of new bone, cementum, and periodontal ligament, which conventional treatment modalities alone often fail to achieve. 4 Over the last decade, scaffold-based biomaterials have gained interest in periodontal regeneration due to their ability to mimic the extracellular matrix and provide a three-dimensional (3D) framework supporting cell attachment, migration, proliferation, and differentiation. 5A variety of scaffolds, such as natural polymers (e.g., collagen, chitosan), synthetic polymers (e.g., PLA, PGA), and composite structures, have been 1,