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.
Highlights
The immune response is an elaborate biologic network that integrates the complex and interconnected processes of pathogen recognition, innate immunity, and adaptive immunity.[1]
The immune system plays an essential role in periodontal homeostasis and the pathogenesis of inflammatory periodontal diseases.[2]
In the field of periodontology, the challenge presented by the polymicrobial plaque biofilm triggers immune and inflammatory processes mediated by a large number of pro-inflammatory and anti-inflammatory cytokines and enzymes
Summary
The immune response is an elaborate biologic network that integrates the complex and interconnected processes of pathogen recognition, innate immunity, and adaptive immunity.[1]. In the field of endodontics the same process occurs as the result of the egress of bacteria and their by-products from the apical foramen to the periapical tissues. Marginal and apical periodontal diseases are considered local inflammatory reactions in response to bacterial challenge. They are multifactorial diseases, their dynamic influenced by the initiating factor. The disease occurs in the context of other host and environmental factors. While the variability in periodontal pathogens undoubtedly conducts the periodontal disease progression, a less explored topic remains the role of the individual variances in the host immune system. Recent research in the field of periodontology has indicated that the major determinant of susceptibility to disease is the nature of the immunoinflammatory response.[3] Marginal
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