Cold atmospheric plasma as a perioperative adjunct in oral surgery: A narrative review of surface activation, decontamination and soft‐tissue healing

Cold atmospheric plasma (CAP) is a non‐thermal ionised gas that generates reactive oxygen and nitrogen species and can modify titanium surface chemistry, inactivate oral pathogens and modulate soft‐tissue repair at temperatures compatible with living tissue. This narrative review synthesises evidence identified through a structured multi‐database search, organised around three points in oral surgical care: pre‐treatment activation of titanium devices, intraoperative decontamination in peri‐implant, periodontal and endodontic surgery, and postoperative oral wound management. For activation, CAP lowers the titanium contact angle and increases osteoblast attachment in vitro and in animals, with early human studies reporting improved implant stability on a surrogate endpoint. For decontamination, CAP disrupts biofilm in vitro but has not consistently outperformed sodium hypochlorite and lacks any surgical trial. For wound care, two controlled human trials, one of them randomised, report accelerated oral epithelialisation, whereas an analgesic effect is inconsistent. The three applications share a common platform but differ in reactive‐species profile, parameters and level of evidence, which stays preclinical for most and clinical only on surrogate endpoints. Standardised multidimensional dosimetry and randomised trials with definitive endpoints remain the principal unmet needs before CAP can be recommended as a routine adjunct in oral surgery.