Bioactive Glass Scaffolds for Periodontal Regeneration: From Ion-Mediated Signaling and Osteoimmunomodulation to Precision Regenerative Dentistry

Background/Objectives: The challenges of periodontal and craniofacial defects are complicated due to the hierarchical organization of oral tissues and the limited competency of the bone–ligament–cementum interface to be used as such an experimental tool. The present paper gives a critical overview of the development of bioactive-glass-based scaffolds for precision regenerative dentistry. Methods: This narrative review evaluates bioactive-glass scaffolds for periodontal and craniofacial regeneration, integrating compositional engineering, therapeutic ion signaling, osteoimmunomodulation, scaffold architecture, translational potential, and evidence limitations. Results: Bioactive glasses act as materials capable of much more than simply offering passive osteoconductive function and behave as dynamic ion delivery platforms that control hydroxycarbonate apatite formation processes, osteogenesis, angiogenesis, immune response, and antimicrobial processes. These effects include pathways such as MAPK/ERK, Wnt/β-catenin, BMP/Smad and macrophage polarization. New approaches at development involve smart and stimuli-responsive system, growth factor delivery, stem cell interfaces and patient-specific biofabrication. Mechanical constraints, degradation control, manufacturing stability and the paucity of clinical data, however, are still important limitations to translation. Conclusions: Bioactive-glass-based scaffolds are a potentially good basis for periodontal and craniofacial regeneration. Mechanistic knowledge filled with information on therapeutic ion engineering, artificial intelligence and digital manufacturing could speed up the realization of patient-specific, multifunctional and clinically translatable regeneration solutions.