Non-Cochrane · intervention · PM42068431
Does endodontic treatment modify serum inflammatory markers of cardiovascular risk in individuals with asymptomatic apical periodontitis? a systematic review and meta-analysis.
Silva Araújo Randerson, Abreu Fonseca Thomaz Erika Bárbara, da Silva Magalhães Elma Izze, et al. · Clinical oral investigations · 2026 · PubMed · doi:10.1007/s00784-026-06857-0
Findings
Population Individuals with asymptomatic apical periodontitis
34 findings
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum tumor necrosis factor-alpha (TNF-alpha) Baseline (before treatment) | MD 2.19 [0.61, 3.76] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum ICAM-1 Post-treatment (follow-up 7 days to 12 months) | MD 32.15 [9.32, 54.99] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum C-reactive protein (CRP) Baseline (before treatment) · Subgroup: Own control group studies | MD 0.05 [0.01, 0.10] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum C-reactive protein (CRP) Baseline (before treatment) | MD 0.24 [0.07, 0.40] GRADE not reported 7 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum interleukin-6 (IL-6) Post-treatment (follow-up 7 days to 12 months) | MD 0.81 [-0.27, 1.90] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum C-reactive protein (CRP) Baseline (before treatment) · Subgroup: External control group studies | MD 2.86 [1.30, 4.43] GRADE not reported 4 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum VCAM-1 Baseline (before treatment) | MD 0.00 [-0.01, 0.02] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum interleukin-6 (IL-6) Post-treatment (follow-up 7 days to 12 months) · Subgroup: Own control group studies | MD -0.04 [-1.46, 1.39] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum tumor necrosis factor-alpha (TNF-alpha) Baseline (before treatment) · Subgroup: External control group studies | MD 4.26 [3.02, 5.50] GRADE not reported 1 study |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum ICAM-1 Baseline (before treatment) | MD 86.49 [63.54, 109.44] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum tumor necrosis factor-alpha (TNF-alpha) Post-treatment (follow-up 7 days to 12 months) · Subgroup: Own control group studies | MD -0.25 [-0.60, 0.10] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum interleukin-6 (IL-6) Baseline (before treatment) · Subgroup: External control group studies | MD 1.55 [0.89, 2.21] GRADE not reported 1 study |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum interleukin-6 (IL-6) Baseline (before treatment) · Subgroup: Own control group studies | MD 0.45 [-1.07, 1.97] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum C-reactive protein (CRP) Post-treatment (follow-up 7 days to 12 months) | MD 0.05 [-0.01, 0.10] GRADE not reported 7 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum interleukin-6 (IL-6) Post-treatment (follow-up 7 days to 12 months) · Subgroup: External control group studies | MD 1.49 [0.82, 2.16] GRADE not reported 1 study |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum tumor necrosis factor-alpha (TNF-alpha) Baseline (before treatment) · Subgroup: Own control group studies | MD 0.11 [-0.74, 0.97] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum tumor necrosis factor-alpha (TNF-alpha) Post-treatment (follow-up 7 days to 12 months) · Subgroup: External control group studies | MD 4.90 [3.60, 6.20] GRADE not reported 1 study |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum VCAM-1 Post-treatment (follow-up 7 days to 12 months) | MD 0.00 [-0.00, 0.01] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum interleukin-6 (IL-6) Baseline (before treatment) | MD 1.01 [0.10, 1.93] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum C-reactive protein (CRP) Post-treatment (follow-up 7 days to 12 months) · Subgroup: Own control group studies | MD 0.04 [0.03, 0.04] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum tumor necrosis factor-alpha (TNF-alpha) Post-treatment (follow-up 7 days to 12 months) | MD 1.04 [-0.38, 2.46] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | Internal control group (healthy individuals; own-control analysis) | Serum C-reactive protein (CRP) Post-treatment (follow-up 7 days to 12 months) · Subgroup: External control group studies | MD 1.24 [0.05, 2.44] GRADE not reported 4 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum tumor necrosis factor-alpha (TNF-alpha) Post-treatment (follow-up 7 days to 12 months) | MD 10.44 [5.75, 15.12] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum tumor necrosis factor-alpha (TNF-alpha) Not stated (Table 3) | SMD 7.26 [3.61, 10.91] Very low Downgraded: imprecision, inconsistency 2 studies · 88 treated; 56 controls participants |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum ICAM-1 Baseline (before treatment) | MD -24404.29 [-111181.52, 62372.93] GRADE not reported 2 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum interleukin-6 (IL-6) Post-treatment (follow-up 7 days to 12 months) | MD 6.42 [5.57, 7.26] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum interleukin-6 (IL-6) Baseline (before treatment) | MD 6.70 [6.10, 7.29] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum C-reactive protein (CRP) Baseline (before treatment) | MD 1.87 [0.60, 3.14] GRADE not reported 7 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum ICAM-1 Post-treatment (follow-up 7 days to 12 months) | MD -44102.04 [-122551.39, 34347.32] Very low Downgraded: imprecision, inconsistency 2 studies · 88 treated; 38 controls participants |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum C-reactive protein (CRP) Post-treatment (follow-up 7 days to 12 months) | MD 0.76 [-0.15, 1.67] Very low Downgraded: imprecision, inconsistency 7 studies · 194 treated; 188 controls participants |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum interleukin-6 (IL-6) Not stated (Table 3) | SMD 6.26 [4.65, 7.87] Very low Downgraded: imprecision, inconsistency 2 studies · 88 treated; 60 controls participants |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum tumor necrosis factor-alpha (TNF-alpha) Baseline (before treatment) | MD 12.16 [6.34, 17.97] GRADE not reported 3 studies |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum VCAM-1 Post-treatment (follow-up 7 days to 12 months) | MD 0.03 [-0.15, 0.21] Very low Downgraded: imprecision, inconsistency 2 studies · 88 treated; 38 controls participants |
| Endodontic treatment (non-surgical treatment or retreatment, with or without surgery) | External control group (healthy reference values or another study's healthy controls) | Serum VCAM-1 Baseline (before treatment) | MD 0.09 [-0.08, 0.26] GRADE not reported 2 studies |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bains 2020 Pre- and post-treatment levels of serum high-sensitivity C-reactive protein in patients with lesions of endodontic origin: A clinical… DOI:10.25259/ajohas_1_2020 | 2020 | 1 other review | Serum C-reactive protein (CRP) | not extracted yet |
| Bakhsh 2022 The impact of apical periodontitis, non-surgical root canal retreatment and periapical surgery on serum inflammatory biomarkers. PMID:35707939 | 2022 | 1 other review | Serum C-reactive protein (CRP); Serum interleukin-6 (IL-6); Serum tumor necrosis factor-alpha (TNF-alpha); Serum ICAM-1; Serum VCAM-1 | not extracted yet |
| Bergandi 2019 Endothelial Dysfunction Marker Variation in Young Adults with Chronic Apical Periodontitis before and after Endodontic Treatment. PMID:30910354 | 2019 | 1 other review | Serum interleukin-6 (IL-6); Serum tumor necrosis factor-alpha (TNF-alpha); Serum ICAM-1; Serum VCAM-1 | not extracted yet |
| Brosco 2009 matched by author and year (probable) | NR | 1 other review | Serum C-reactive protein (CRP) | not extracted yet |
| Garrido 2024 Reduced C-reactive protein levels after root canal treatment in clinically healthy young apical periodontitis individuals at… PMID:38243897 | 2024 | 1 other review | Serum C-reactive protein (CRP); Serum interleukin-6 (IL-6); Serum tumor necrosis factor-alpha (TNF-alpha) | not extracted yet |
| Kumar 2022 Comparative Evaluation of Serum High-sensitivity C-Reactive Protein and Complete Hemogram Indices in Subjects with and without Apical… PMID:35577144 | 2022 | 1 other review | Serum C-reactive protein (CRP) | not extracted yet |
| Marton & Kiss 1992 Influence of surgical treatment of periapical lesions on serum and blood levels of inflammatory mediators. PMID:1291518 | 1992 | 1 other review | Serum C-reactive protein (CRP) | not extracted yet |
| Poornima 2021 Impact of root canal treatment on high-sensitivity C-reactive protein levels in systemically healthy adults with apical periodontitis - a… PMID:33185278 | 2021 | 1 other review | Serum C-reactive protein (CRP) | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Impact of Endodontic Treatment of Teeth With Apical Periodontitis on Levels of Inflammatory Biomarkers Associated With Cardiovascular… (2026) | 8 | 0.40 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals with asymptomatic apical periodontitis, systemically healthy | Individuals aged 16 to 75 years with apical periodontitis (n=8 studies; sample sizes 11 to 115) |
| Intervention | Endodontic treatment | Conventional nonsurgical endodontic treatment (n=6), nonsurgical with surgical complement (n=1), retreatment versus periapical surgery (n=1) |
| Comparison | Post-treatment values and external control of healthy individuals | Internal healthy control group (n=4 studies) or external controls imputed from another study or reference values (n=4 studies) |
| Outcomes | Inflammatory markers of cardiovascular risk (cytokines and biomarkers) | CRP (n=7), IL-6, TNF-alpha, ICAM-1, VCAM-1 (n=2 to 3 each) pooled; 23 markers evaluated overall |
| Study designs | Observational (cohort, case-control) and experimental studies including before-and-after studies | Before-and-after studies with or without cross-sectional controls, cohort, prospective interventional studies |
| Timing | Not specified | Follow-up 7 days to 12 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: Partial Yes | NRSI: Partial Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: No | NRSI: No · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |