Immunomodulation in Endodontic Inflammation: Current Insights and Future Directions
Manisha Sharma, Tony Mathew, Mamidala Malvika, Sharvari K. BhatAbstract
Objective:
Endodontic inflammation, particularly pulpitis and apical periodontitis, arises from complex interactions between microbial infection and host immune responses. While conventional endodontic therapy focuses on microbial elimination, persistent inflammation driven by host immune dysregulation significantly influences treatment outcomes. This review aimed to evaluate the current understanding of immunomodulatory mechanisms involved in endodontic inflammation and to explore emerging therapeutic strategies targeting host immune responses.
Methods:
A narrative review with a structured search strategy was conducted using PubMed, Scopus, and Google Scholar databases. Studies published in English between January 2000 and March 2025 were screened using predefined inclusion and exclusion criteria. This study selection process included database searching, duplicate removal, title and abstract screening, and full-text assessment of eligible articles.
Results:
The database search identified 312 articles, of which 72 duplicates were removed. After screening titles and abstracts, 240 articles were evaluated, and 168 were excluded for not meeting the inclusion criteria. Seventy-two full-text articles were assessed, and 22 studies were ultimately included in the qualitative synthesis. The literature demonstrates that immunomodulatory strategies, including pharmacological agents, biologics, biomaterials, natural compounds, and nanotechnology-based delivery systems, can regulate inflammatory pathways, suppress pro-inflammatory cytokines, and promote tissue repair in endodontic lesions.
Conclusion:
Current evidence suggests that host response modulation represents a promising adjunctive approach in endodontic therapy. Although substantial