Autophagy and Angiogenesis in Oral and Maxillofacial Regions: A Key to Understanding Periodontal Disease and Regeneration

The oral and maxillofacial regions are abundant in vascular tissue, and dental pulp regeneration involves in situ pulp revascularization. Angiogenesis plays a crucial role in alterations to the maxillofacial region and reconstruction of periodontal tissue. While angiogenesis is essential for growth, tissue remodeling, and repair, dysregulation of angiogenesis in the oral cavity can lead to the development and progression of oral submucous fibrosis (OSF), maxillofacial cancer metastasis, and other pathologies [114].

Numerous studies have demonstrated that autophagy is involved in the angiogenesis of periodontitis, skin wound healing, oral mucosa, and oral tissue cancer. In one study, it was found that both chronic and aggressive forms of periodontitis significantly increased HIF-1α and VEGF expression in gingival crevicular fluid and saliva [115]. Furthermore, autophagy levels and angiogenin in PDLSCs were increased in the periodontitis microenvironment [116]. Autophagy enhancement increased the tube formation ability of PDLSCs, while autophagy blocking decreased angiogenesis in PDLSCs. This could explain why periodontitis patients are more prone to gingival bleeding.