This systematic review explores the role of osteosynthesis in enhancing periodontal bone regeneration, emphasizing its clinical relevance in treating alveolar bone defects caused by periodontal disease. The study focuses on how different fixation systems and biomaterials contribute to both healing efficiency and clinical stability, highlighting their importance in achieving long-term periodontal restoration. Following the PRISMA 2020 guidelines, a systematic electronic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library for studies published between 2018 and 2025. A total of 27 studies with sample sizes ranging from 10 to 13,392 participants were included. Titanium-based osteosynthesis systems (Ti6Al4V and CpTi) accounted for 80% of the studies, achieving 97-100% success rates with 0-6.7% complication rates and healing times of 3-26 weeks, with more than 95% radiographic or histological union. Magnesium-based alloys (MgYREZr and WE43) demonstrated comparable fixation strength with 3-5% complications, whereas polymeric and hybrid biomaterials such as PLLA-PGA, PLGA, SmartBone®, and u-HA/PLLA exhibited superior osteoconductivity with 100% graft integration. CAD/CAM and patient-specific osteosynthesis improved surgical precision by 15-20%. This review highlights the novelty of combining osteosynthetic fixation with bioactive and biodegradable regenerative technologies. Titanium remains the benchmark, while magnesium, polymeric, and hybrid biomaterials offer bioresorbable and patient-specific alternatives, advancing the future of periodontal regenerative surgery. The findings contribute to improving clinical decision-making and optimizing biomaterial selection for superior periodontal outcomes.
