The Role of the Immune Response in Chronic Marginal and Apical Periodontitis

Abstract

The immune response is a complex, dynamic and strongly individual biologic network that plays an essential role in the pathogenesis of chronic apical and marginal periodontitis. Recent research in the field of periodontology has indicated that the major determinant of susceptibility to disease is the nature of the immunoinflammatory response as marginal periodontal tissue damage is thought to be primarily mediated by the host reaction. Whether the same rules apply for the development of apical periodontitis, however, remains largely unexplored. This review aims to draw parallels between the pathogenesis of chronic periodontitis of endodontic and marginal origin, outline the evidence for the destructive role of immune response in chronic marginal periodontitis and raise questions about its role in chronic apical periodontitis. It would be worthy to further explore the impact of the immune system on the characteristics and progress of these diseases and transfer some of the scientific models from the field of periodontology to the field of endodontics. Research in this area could lead to a more comprehensive understanding of the dynamics of apical and marginal periodontitis and lay the foundation of new personalized treatment strategies. 

The Potential Role of Epigenetic Modifications on Different Facets in the Periodontal Pathogenesis

“…It takes more time to activate and generate specialized cells with distinct functions such as recognizing antigens (self from non-self), eliminating pathogens, and creating immune memory [ 34 ]. The interaction between innate and adaptive immunity is complex, both are essential in maintaining health and homeostasis, they consist of humoral and cellular immune responses, which include antibody production and defense mechanisms [ 36 ]. The inflammation triggered by injury, infection or pathogens is usually self-limiting and leads to tissue repair.…”

“…It is a highly prevalent, if not the most prevalent, form of inflammation in the tooth and its periodontium. This disease is initiated by the dysbiosis of the oral microbiome and quickly evolves into an inflammatory and immune response [ 36 ]. When maintaining a constant aggression of the tissue by pathogens, this reaction shifts from an innate to an adaptive one.…”

Therapeutic Potential of Chlorhexidine-Loaded Calcium Hydroxide-Based Intracanal Medications in Endo-Periodontal Lesions: An Ex Vivo and In Vitro Study

“…These infections activate an inflammatory response that leads to local resorption of the alveolar bone supporting the tooth [6][7][8]. The mechanisms involved in tissue destruction include many cellular players (polymorphonuclear neutrophils [PMN], macrophages, TH1, TH2, and TH17 cells, Antibiotics 2023, 12, 1416 2 of 20 B lymphocytes, and osteoclasts) and are regulated by molecular mediators such as IL-1β, IL-6, IL-17, TNF-α, and RANKL/OPG [9].…”