Inflammaging in periodontal, periapical, and malignancy-associated disease: drivers of alveolar bone loss and repair

BACKGROUND: Aging significantly impacts bone metabolism through altered osteoblast/osteoclast dynamics, reduced stem cell regeneration, and chronic inflammaging. This narrative review explores how these age-related changes influence alveolar bone loss and regeneration in the oral cavity. METHODS: The review investigates key mechanisms-including immunosenescence and inflammasome activation-across three specific pathological contexts: (1) periodontitis, (2) periapical bone resorption, and (3) malignancy-associated osteolysis. Preclinical and clinical evidence were integrated to analyze the bone-immune equilibrium. RESULTS: Aging was found to skew the immune environment, exacerbating bone destruction. The review identifies emerging immunomodulatory strategies to rejuvenate bone healing, such as targeting senescent cells (senolytics) and inflammatory cytokines to modulate the immune microenvironment. CONCLUSION: Addressing the unique challenges of the aging population is critical for regenerative dentistry. Future research must bridge current gaps to translate immunomodulatory insights into clinical therapies for improving alveolar bone regeneration in older patients.