Immunomodulation Strategies to Enhance Oral Bone Regeneration

Abstract

Several volumetric and qualitative bone limitations may contraindicate the use of bone-supported oral rehabilitation, which remains the gold standard for edentulous ridges. However, oral bone regeneration is a multifaceted process influenced by immune responses, cellular dynamics, and systemic factors. Moreover, its predictability in clinical settings remains limited, leading to challenges in consistently achieving the desired regenerative outcomes. This chapter explores immunomodulation strategies as innovative approaches to enhance alveolar bone regeneration, addressing the challenges of bone healing and repair. Traditional methods such as grafting and biomaterials, while effective, face limitations, including donor site morbidity and immune rejection. Thus, immunotherapy approaches emphasizing cell-based therapies (macrophage polarization, cytokines, and mesenchymal stem cells), material-based strategies (bioactive scaffolds and nanoparticles), and other supporting approaches like anti-inflammatory drugs and lifestyle interventions will be outlined. Even though preclinical studies suggest that some of these techniques can be crucial in the maintenance or resolution of the inflammation and thereby directing bone healing, several uncertainties remain regarding their clinical validation. Additionally, insights on the role of emerging strategies, such as photodynamic therapy (PDT) and near-infrared light (NIR) therapy, will be explored, considering their impact on immunity, infection, and bone repair. All these strategies can be combined to synergistically and positively affect outcomes in bone regeneration.

Keywords: Alveolar bone regeneration; Bioactive scaffolds; Immunomodulation; Photodynamic therapy (PDT).