# Biostimulation-Based Approaches for Gingival Tissue Augmentation in Thin Periodontal Phenotype: Potential Applications for Orthodontic Patients

## TL;DR

This paper reviews biostimulation techniques for improving gum tissue in patients with a thin periodontal structure, focusing on their potential use in orthodontic treatments.

## Contribution

The paper evaluates the clinical evidence of various biostimulation methods for soft tissue augmentation in orthodontic patients with a thin periodontal phenotype.

## Key findings

- Injectable platelet-rich fibrin and microneedling show short-term benefits for soft tissue thickening.
- Current evidence is limited by small trials and non-orthodontic cohorts.
- More robust, long-term studies are needed to validate biostimulation as a reliable alternative to surgery.

## Abstract

Gingival recession, particularly in patients exhibiting a thin periodontal phenotype, is a prevalent and challenging complication associated with orthodontic treatment, among other factors. Recent advances in biostimulation therapies aim to support soft tissue augmentation by increasing gingival thickness (GT) and keratinized tissue width (KTW) while minimizing the need for invasive surgical procedures. This narrative review explores the available clinical evidence regarding several biostimulation techniques, including injectable platelet-rich fibrin (i-PRF), microneedling (MN), concentrated growth factors (CGF), atelocollagen, hyaluronic acid (HA), and low-level laser therapy (LLLT), with a particular focus on their potential adjunctive role in orthodontic patients with a thin periodontal phenotype. While i-PRF and microneedling—used alone or in combination—have shown promising short-term soft tissue thickening and reduced patient morbidity when compared with conventional grafting procedures, the available evidence is largely derived from small, randomized trials, pilot studies, and non-orthodontic cohorts, limiting the strength of comparative conclusions. Minimally invasive biostimulation techniques may represent potential adjunctive strategies for soft tissue management in selected clinical scenarios. Nevertheless, current evidence remains limited and heterogeneous, and robust, long-term, orthodontic-specific clinical trials are required before these approaches can be considered reliable alternatives to established surgical protocols or validated preventive strategies against gingival recession.