Epigenetic modifications as a biomarker for periodontitis and peri-implantitis: a review

The study of epigenetics is critical for understanding the interplay between genetic susceptibility and environmental influences in diseases like periodontitis and peri-implantitis. Epigenetic modifications—including DNA methylation, histone modifications, and non-coding RNA activity—can alter gene expression without changing the DNA structure, thereby impacting disease progression and tissue destruction. This review brings updated and straightforward information on the role of epigenetics in the pathogenesis of periodontal and peri-implant diseases, highlighting the contributions of microbial factors, host immunity, and systemic conditions like diabetes. Recent advancements in genomic sciences, such as high-throughput sequencing and methylation profiling, have revealed specific patterns of DNA methylation and chromatin modifications that precede pathological states. These findings enhance our understanding of the molecular pathology of periodontal and peri-implant infections and suggest novel treatment approaches to reverse the epigenetic effects associated with disease progression. Histone modifications also play a significant role in regulating periodontal disease by altering DNA accessibility for gene transcription, affecting genes involved in immune response and inflammation. Non-coding RNAs, particularly microRNAs, have been identified as critical regulators of inflammatory pathways and potential therapeutic targets. The epigenetic landscape is further complicated by systemic diseases like diabetes, which can influence epigenetic modifications and exacerbate periodontal inflammation and tissue destruction. Understanding these interactions is essential for developing comprehensive preventive protocols and therapeutic strategies. Epigenetic therapies, or "epidrugs", offer promising new treatment modalities by targeting specific epigenetic modifications to normalize gene function and facilitate tissue repair. However, a thorough understanding of epigenetic mapping in these diseases is required, necessitating further epidemiologic studies to identify the exact modifications involved. In conclusion, integrating epigenetic research into periodontology provides a promising approach better to understand gene-environment-microbiome interactions in periodontal and peri-implant diseases. This integration could lead to developing new therapies and preventive strategies, ultimately improving clinical outcomes for patients affected by these conditions.