The versatile roles of macrophages in the homeostasis and pathogenesis of orofacial hard tissues

Macrophages are emerging as central regulators of the osteoimmune microenvironment in orofacial hard tissues, where unique mechanical, vascular and microbial cues shape a highly dynamic immune landscape. This review integrates the evidence for recently identified macrophage subpopulations; highlights how local mechanical, vascular, and inflammatory cues shape macrophage heterogeneity; and discusses how these context-dependent programmes contribute to tissue maintenance, regeneration, and pathology. We also summarize cutting-edge therapeutic strategies, shifting focus from broad immunosuppression to precise immunomodulation. A better understanding of macrophage phenotypic plasticity and spatiotemporal dynamics will provide novel insights for the treatment and research of orofacial hard tissue diseases.