Non-Cochrane · intervention · PM42193431
Periodontitis, Endothelial Dysfunction, and Systemic Inflammation: A Systematic Review and Meta-Analysis of Flow-Mediated Dilation.
Ples Cristina, Savencu Cristina, Pah Ana-Maria, et al. · Biomedicines · 2026 · PubMed · doi:10.3390/biomedicines14051106
Findings
4 findings
| Population | ||||
|---|---|---|---|---|
| Adults with clinically diagnosed periodontitis | Periodontal therapy (non-surgical, scaling and root planing, or intensive protocols) | Control or standard care, less intensive therapy, or baseline (within-subject) | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) Short to intermediate follow-up (24 h to 12 months across studies) | MD 3.3 [1.7, 4.9] 3.3 [1.7, 4.9] percentage points FMD Moderate Downgraded: risk of bias 6 studies · 340 participants |
| Adults with clinically diagnosed periodontitis | Periodontal therapy (non-surgical, scaling and root planing, or intensive protocols) | Control or standard care, less intensive therapy, or baseline (within-subject) | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) Short to intermediate follow-up (24 h to 12 months across studies) · Sensitivity analysis restricted to randomized controlled trials | Sensitivity analyses restricted to randomized controlled trials showed a smaller and non-significant effect on FMD (numeric estimate not reported) GRADE not reported Studies not reported |
| Adults with periodontitis (clinically diagnosed periodontal disease) | Periodontal therapy (non-surgical therapy such as scaling and root planing, or intensive protocols) | Control groups (standard care or less intensive therapy) or baseline measurements in within-subject studies | Interleukin-6 (IL-6) After periodontal therapy · Clinical studies | Favorable trend toward reduction; direction of effect favorable, quantitative pooling not performed due to heterogeneity and inconsistent reporting of units Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 200 participants |
| Adults with clinically diagnosed periodontitis | Periodontal therapy (non-surgical, scaling and root planing, or intensive protocols) | Control or standard care, less intensive therapy, or baseline (within-subject) | C-reactive protein (CRP, mg/L) Post-therapy | MD -0.38 [-0.52, -0.24] -0.38 [-0.52, -0.24] mg/L Moderate Downgraded: risk of bias 5 studies · 280 participants |
Included primary studies 15
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Amar 2003 Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. PMID:12763762 | 2003 | this review only | not stated | not extracted yet |
| Blum 2007 Periodontal care may improve endothelial function. PMID:17574103 | 2007 | this review only | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) | not extracted yet |
| D'Aiuto 2004 Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. PMID:14742655 | 2004 | this review only | not stated | not extracted yet |
| Higashi 2008 Periodontal infection is associated with endothelial dysfunction in healthy subjects and hypertensive patients. PMID:18039979 | 2008 | this review only | not stated | not extracted yet |
| Holtfreter 2013 Periodontitis is associated with endothelial dysfunction in a general population: a cross-sectional study. PMID:24386401 | 2013 | this review only | not stated | not extracted yet |
| Ide 2004 The short-term effects of treatment of chronic periodontitis on circulating levels of endotoxin, C-reactive protein, tumor necrosis… PMID:15088881 | 2004 | this review only | not stated | not extracted yet |
| Mercanoglu 2004 Endothelial dysfunction in patients with chronic periodontitis and its improvement after initial periodontal therapy. PMID:15732873 | 2004 | this review only | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) | not extracted yet |
| Molina 2025 Effect of periodontal therapy on endothelial function and serum biomarkers in patients with periodontitis and established cardiovascular… PMID:39996093 | 2025 | this review only | not stated | not extracted yet |
| Okada 2021 Effect of advanced periodontal self-care in patients with early-stage periodontal diseases on endothelial function: An open-label,… PMID:34555048 | 2021 | this review only | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) | not extracted yet |
| Piconi 2009 Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness. PMID:19074511 | 2009 | this review only | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) | not extracted yet |
| Seinost 2005 Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. PMID:15976787 | 2005 | this review only | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) | not extracted yet |
| Tonetti 2007 Treatment of periodontitis and endothelial function. PMID:17329698 | 2007 | this review only | Endothelial function: brachial artery flow-mediated dilation (FMD, percentage points) | not extracted yet |
| Velosa-Porras 2021 Endothelial Dysfunction, its Relationship with Chronic Periodontal Disease, and other Associated Risk Factors DOI:10.2174/1874210602115010377 | 2021 | this review only | not stated | not extracted yet |
| Velosa-Porras 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Vidal 2009 Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and… PMID:19405832 | 2009 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults with clinically diagnosed periodontitis or periodontal disease | Adults with periodontitis (mostly moderate to severe chronic periodontitis; some with hypertension or cardiovascular disease) |
| Intervention | Periodontal therapy (non-surgical therapy such as scaling and root planing, or intensive protocols) | Scaling and root planing, non-surgical periodontal therapy, intensive periodontal therapy, advanced self-care (interventional studies n=10) |
| Comparison | Periodontally healthy individuals, control groups with standard care or less intensive therapy, or baseline measurements in within-subject studies | Healthy controls (observational studies), standard or less intensive care, or baseline comparison |
| Outcomes | Endothelial function (flow-mediated dilation of the brachial artery or forearm blood flow plethysmography); CRP; IL-6 | FMD (6 studies pooled; N approx 340); CRP (5 studies; N approx 280); IL-6 (3 studies; N approx 200; not pooled); CIMT descriptive |
| Study designs | Observational (cross-sectional, case-control) and interventional studies (RCTs and non-randomized), English language | 14 studies: 4 randomized trials (including 1 pilot), 6 non-randomized interventional studies, 2 case-control studies, 2 cross-sectional studies |
| Timing | Not specified | 24 h to 12 months after therapy; observational studies cross-sectional |
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 | Yes | no |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 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 | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |