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dynamic shifts in immune cell subsets, such as the selective death of M2 macrophages, further skewing the microenvironment toward pro-inflammatory states ( 2.4.2 Pathological consequences and clinical significance This vicious cycle leads to persistent ferroptosis in PDLCs and gingival epithelial cells, triggering periodontal ligament degeneration, disruption of the gingival barrier, and alveolar bone resorption