PATHOGENETIC MECHANISMS OF INFLAMMATORY RESORPTION OF JAW BONES IN APICAL PERIODONTITIS

Apical periodontitis (AP) is characterized by persistent inflammatory reactions and progressive resorption of alveolar bone initiated by microbial infection, posing significant risks to both oral and systemic health. Although contemporary nonsurgical antimicrobial treatment of periapical lesions demonstrates high clinical effectiveness, many cases remain resistant to conventional endodontic therapy. Improvement of treatment outcomes requires deeper understanding of the pathogenetic mechanisms underlying formation of the inflammatory microenvironment in apical periodontitis. The present review summarizes modern concepts regarding inflammatory resorption of periapical tissues, in which microbial invasion activates immune cells and triggers formation of an inflammatory microenvironment that disrupts bone homeostasis. Particular emphasis is placed on destructive mechanisms associated with immune activation, cytokine imbalance, oxidative stress, and disturbances of lipid peroxidation processes within periapical tissues. Understanding these mechanisms provides a basis for development of novel therapeutic strategies, including targeted anti-inflammatory therapy, antioxidant treatment, cytokine modulation, and cell-based regenerative approaches aimed at prevention of progressive bone destruction.