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

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.