Evolution, current concepts and future perspectives of bone grafts in periodontal regeneration

Objective: This comprehensive review examines the historical evolution, biological foundations, classifications, and comparative efficacy of bone replacement grafts and synthetic substitutes used in periodontal regenerative therapy.
Methodology: A detailed synthesis of anatomical, physiological, and clinical literature was conducted, incorporating historical dental milestones and contemporary systematic reviews evaluating autogenous, allogeneic, xenogeneic, and alloplastic biomaterials.
Key Results: Periodontal regeneration requires an environment conducive to restoring the hard and soft tissue attachment apparatus. Autogenous bone remains the gold standard due to its triad of osteogenic, Oste inductive, and osteoconductive properties, though limited by donor-site morbidity. Allografts (FDBA and DFDBA) exhibit strong clinical efficacy without risk of cross-sensitization. Xenografts (BDX and coralline materials) offer structural architectural scaffolds with low immunogenicity. Modern allowlists (hydroxyapatite, β-tricalcium phosphate, calcium sulfate, and bioactive glasses) show predictable clinical attachment level (CAL) gains and probing depth (PD) reductions, acting primarily through Oste conduction, which is enhanced when combined with growth factors like PDGF-BB.
Conclusion: Successful periodontal reconstruction depends on selecting appropriate biomaterials based on defect morphology, maintaining absolute graft immobilization, ensuring soft-tissue coverage, and leveraging the bone induction cascade to achieve true histological regeneration over simple tissue repair.