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

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.