Synergistic Epigenetic and Post-Transcriptional Regulation of Alveolar Bone Resorption

Alveolar bone resorption, which accompanies periodontitis, post-extraction mechanical unloading, and aging-related inflammation, is governed by interacting epigenetic and post-transcriptional mechanisms. Evidence from DNA methylation, histone modification, non-coding RNA (ncRNA), RNA-binding protein, and N6-methyladenosine (m6A) studies indicates that these layers jointly regulate the balance between bone formation and resorption, although their causal hierarchy and tissue specificity remain incompletely defined. This review integrates that evidence into a graded framework that separates mechanisms demonstrated functionally in alveolar bone or periodontal models from those supported only by correlational data or extrapolated from long-bone, calvarial, and osteoporosis models, and assigns each mechanism to the cell types in which it has been demonstrated. Because the effects of individual regulators (for example, DNMTs, HDACs, and m6A writers) depend on cell type, differentiation stage, dose, and timing, conflicting reports are examined explicitly. We further dissect the bidirectional crosstalk between epigenetic modifiers and ncRNAs, distinguishing experimentally verified links from hypothetical ones, and critically assess emerging therapeutic strategies—small-molecule epigenetic inhibitors, oligonucleotide therapeutics, and biomaterial-assisted delivery—together with their safety and delivery barriers. By formalizing an evidence-graded conceptual framework, this review provides a basis for mechanism-based strategies against alveolar bone resorption.