Biomaterial strategies for precision regeneration of the tooth extraction socket: integrating site phenotype, pathological microenvironment, and healing sequence.

Alveolar ridge remodeling after tooth extraction is not merely a process of bone defect repair; rather, it is jointly regulated by the anatomical phenotype, pathological microenvironment, surgical procedures, subsequent restorative objectives, and temporal healing sequence of the socket. Existing studies on extraction socket biomaterials are largely categorized by material composition or isolated osteogenic properties, and have yet to adequately address what the dominant regenerative barrier is at a given site, which material functions are clinically necessary, and whether increasing functional complexity translates into patient-relevant benefits. Using a critical narrative review approach, this article comprehensively analyzes the anatomical characteristics, pathological states, surgical and restorative contexts, and staged healing events of healthy and compromised extraction sockets, with particular emphasis on the impact of blood clot and regenerative space instability, biofilm and persistent inflammation, oxidative stress overload, insufficient angiogenesis, and osteogenesis-bone remodeling imbalance on material efficacy. In this review, the term "precision regeneration" refers to the selection of a minimally necessary combination of functions based on the site phenotype and its dominant barriers, rather than the indiscriminate stacking of antibacterial, anti-inflammatory, pro-angiogenic, and osteogenic functions. On this basis, we evaluate the applicability boundaries, directness of supporting evidence, and translational limitations of natural polymers, synthetic polymers, bioceramics, composite materials, and bioactive factor delivery systems across the functional dimensions of blood clot stabilization and wet-environment adhesion, space maintenance and osteoconduction, antibiofilm and immunomodulatory activity, osteogenesis-angiogenesis coupling, pathological microenvironment responsiveness, and anatomical adaptation. We further propose a decision framework of "site phenotype-dominant barrier-minimal necessary functions-material strategy-clinical net benefit," and discuss key issues including mismatch between degradation and regeneration rates, residual materials, host cell cytotoxicity, burst release of bioactive factors, manufacturing complexity, and long-term safety. This framework is intended to drive the transition of socket preservation from empirical selection driven by material category and functional quantity toward precision regeneration strategies grounded in clinical phenotype, biological requirements, and patient outcomes.