Autologous circulating stem cells in dental implants: Core applications, risks and mitigation strategies: A systematic review

Dental implants have become the gold standard for restoring edentulism, but their long-term success is contingent on osseointegration and soft tissue healing. Autologous circulating stem cells (aCSCs), including autologous hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs), have emerged as promising seed cells for enhancing implant osseointegration and repairing peri-implant defects due to their minimally invasive acquisition, self-renewal capacity, multi-directional differentiation potential, and low immune rejection risk. However, the unique oral microenvironment and complex clinical procedures introduce multiple risks including infection and insufficient cell viability that hinder the clinical translation of aCSCs in dental implantology. This systematic review summarizes the core applications of aCSCs in dental implants, categorizes and analyzes the potential risks (with emphasis on infection rate and cell viability), and proposes targeted mitigation strategies. We searched PubMed, Web of Science, Scopus, and Cochrane Library databases for relevant studies published between 2018 and 2026, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 187 studies were initially retrieved, and 40 eligible studies were included for in-depth analysis. The results indicate that aCSCs can effectively promote osseointegration, repair peri-implant bone defects, and improve soft tissue attachment around implants, with an average post-thaw viability of 85%–92% when optimized protocols are applied. Nevertheless, five categories of risks were identified: infection-related risks (overall incidence of 2.1%–4.8% in clinical trials), cell-specific risks, oral microenvironment-specific risks, technical and normative risks, and individualized management risks. Mitigation strategies should focus on strict infection control, optimized aCSC preparation protocols, targeted adaptation to the oral microenvironment, establishment of standardized operating procedures, and individualized perioperative management. This review provides a comprehensive evidence-based foundation for addressing safety concerns and promoting the rational application of aCSCs in dental implantology, while highlighting future research directions to optimize efficacy and safety