Non-Cochrane · intervention · PM42708155
Efficacy of omega-3 fatty acids supplementation as an adjunct to nonsurgical periodontal therapy in periodontitis: a systematic review and meta-analysis of randomized controlled trials.
Irmawati Anis, Muhammad Ridho Fiki, Labib Raed, et al. · Revista cientifica odontologica (Universidad Cientifica del Sur) · 2026 · PubMed · doi:10.21142/2523-2754-1403-2026-303
Findings
33 findings
| Population | ||||
|---|---|---|---|---|
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Maybodi et al. (2022) | MD -0.66 [-0.99, -0.33] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Baseline Probing pocket depth Baseline | MD 0.03 [-0.08, 0.13] GRADE not reported 9 studies · 362 participants |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 6 months · Supplementation duration: 6 months | MD -0.70 [-0.94, -0.45] GRADE not reported 3 studies · 120 participants |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Elgendy et al. (2018) | MD -0.64 [-0.98, -0.31] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 3 months · Supplementation duration: 3 months | MD -0.69 [-1.23, -0.15] GRADE not reported 5 studies · 192 participants |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting El-Sharkawy et al. (2017) | MD -0.60 [-0.91, -0.29] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 3 to 6 months · Low risk of bias | MD -0.72 [-0.93, -0.52] GRADE not reported 5 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Umrania et al. (2017) | MD -0.83 [-1.02, -0.64] GRADE not reported 7 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Baseline Clinical attachment level Baseline | MD 0.04 [-0.07, 0.16] GRADE not reported 8 studies · 312 participants |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Stando et al. (2020) | MD -0.71 [-1.03, -0.38] GRADE not reported 8 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting El-Sharkawy et al. (2017) | MD -0.61 [-0.90, -0.31] GRADE not reported 7 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Deore et al. (2014) | MD -0.63 [-0.94, -0.33] GRADE not reported 7 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Elgendy et al. (2018) | MD -0.69 [-1.01, -0.36] GRADE not reported 7 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Shalaby et al. (2019) | MD -0.63 [-0.95, -0.31] GRADE not reported 8 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Stando-Retecka et al. (2023) | MD -0.72 [-1.03, -0.41] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 3 months · Supplementation duration: 3 months | MD -0.67 [-1.15, -0.19] GRADE not reported 6 studies · 242 participants |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Salman et al. (2014) | MD -0.58 [-0.88, -0.29] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 3 to 6 months · EPA plus DHA <1000 mg/day | MD -0.67 [-1.15, -0.06] GRADE not reported 5 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Maybodi et al. (2022) | MD -0.70 [-1.01, -0.39] GRADE not reported 7 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 3 to 6 months · Some concerns for risk of bias | MD -0.66 [-1.40, 0.08] GRADE not reported 3 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 3 to 6 months · Some concerns for risk of bias | MD -0.84 [-1.57, -0.10] GRADE not reported 4 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 3 to 6 months | MD -0.69 [-1.06, -0.32] Low Downgraded: inconsistency 8 studies · 312 participants |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Deore et al. (2014) | MD -0.67 [-1.01, -0.33] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 3 to 6 months | MD -0.66 [-1.03, -0.30] Low Downgraded: inconsistency 9 studies · 362 participants |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 3 to 6 months · Low risk of bias | MD -0.56 [-0.79, -0.33] GRADE not reported 5 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Stando et al. (2020) | MD -0.66 [-0.96, -0.36] GRADE not reported 7 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 3 to 6 months · EPA plus DHA ≥1000 mg/day | MD -0.66 [-1.16, -0.16] GRADE not reported 4 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Shalaby et al. (2019) | MD -0.65 [-0.96, -0.34] GRADE not reported 7 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 3 to 6 months · EPA plus DHA <1000 mg/day | MD -0.69 [-1.22, -0.17] GRADE not reported 5 studies |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Clinical attachment level (CAL) 3 to 6 months · Leave-one-out sensitivity: omitting Stando-Retecka et al. (2023) | MD -0.70 [-1.00, -0.39] GRADE not reported 7 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Probing pocket depth 6 months · Supplementation duration: 6 months | MD -0.66 [-1.13, -0.20] GRADE not reported 3 studies · 120 participants |
| Adults with clinically diagnosed moderate to severe (stage II-IV) periodontitis, non-diabetic | Omega-3 fatty acid (EPA+DHA) supplementation after scaling and root planing | Scaling and root planing alone or with placebo | Probing pocket depth (PPD) 3 to 6 months · Leave-one-out sensitivity: omitting Umrania et al. (2017) | MD -0.77 [-1.04, -0.50] GRADE not reported 8 studies |
| Adults with moderate to severe or stage II-IV periodontitis | Omega-3 fatty acid supplementation plus scaling and root planing | Scaling and root planing with or without placebo | Clinical attachment level 3 to 6 months · EPA plus DHA ≥1000 mg/day | MD -0.67 [-0.93, -0.41] GRADE not reported 3 studies |
Included primary studies 9
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Stando 2020 Omega-3 Polyunsaturated Fatty Acids EPA and DHA as an Adjunct to Non-Surgical Treatment of Periodontitis: A Randomized Clinical Trial. PMID:32867199 | 2020 | 3 other reviews | not stated | not extracted yet |
| Deore 2014 Omega 3 fatty acids as a host modulator in chronic periodontitis patients: a randomised, double-blind, palcebo-controlled, clinical trial. PMID:24616831 | 2014 | 2 other reviews | not stated | not extracted yet |
| Maybodi 2022 Effects of omega-3 supplementation as an adjunct to non-surgical periodontal therapy on periodontal parameters in periodontitis patients:… PMID:36414947 | 2022 | 2 other reviews | not stated | not extracted yet |
| Stando-Retecka 2023 Clinical and microbiological outcomes of subgingival instrumentation supplemented with high-dose omega-3 polyunsaturated fatty acids in… PMID:37179297 | 2023 | 2 other reviews | not stated | not extracted yet |
| Umrania 2017 Evaluation of dietary supplementation of omega-3 polyunsaturated fatty acids as an adjunct to scaling and root planing on salivary… PMID:29491585 | 2017 | 2 other reviews | not stated | not extracted yet |
| El-Sharkawy 2017 THE IMPACT OF OMEGA-3 FATTY ACIDS COMBINED WITH INITIAL PERIODONTAL THERAPY ON SALIVARY VISFATIN AND TNF-Α LEVELS IN CHRONIC PERIODONTITIS… DOI:10.21608/edj.2017.74541 | 2017 | 1 other review | not stated | not extracted yet |
| Elgendy 2018 Effect of Omega-3 Fatty Acids on Chronic Periodontitis Patients in Postmenopausal Women: A Randomised Controlled Clinical Study. PMID:30175329 | 2018 | 1 other review | not stated | not extracted yet |
| Salman 2014 Omega-3 as an adjunctive to non surgical treatment of chronic periodontitis patients DOI:10.9790/0853-13610811 | 2014 | this review only | not stated | not extracted yet |
| Shalaby 2019 Evaluation of adjunctive effect of daily dietary supplements with omega 3 and propolis to non-surgical periodontal therapy: Randomized… DOI:10.21608/edj.2019.74811 | 2019 | this review only | not stated | 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 question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>=18 years) with moderate to severe or stage II to IV periodontitis (2017 AAP or pre-2017 criteria) | Adults with moderate to severe or stage II-IV chronic periodontitis (n=362 for PPD, n=312 for CAL) |
| Intervention | Omega-3 fatty acid or fish oil capsules administered after SRP with clear total dose or EPA and DHA dose, as the single adjunct | Omega-3 fatty acids 300 to 4,400 mg/day EPA+DHA after SRP (n=9 RCTs) |
| Comparison | SRP with or without placebo | SRP alone or with placebo |
| Outcomes | Probing pocket depth (PPD) and clinical attachment level (CAL); adverse events (secondary) | PPD (9 RCTs); CAL (8 RCTs); baseline PPD and CAL balance; adverse events (narrative) |
| Study designs | Parallel-group RCTs with at least two groups | RCTs (n=9) |
| Timing | Follow-up of at least 3 months | 3 months (6 RCTs) and 6 months (3 RCTs) |
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 | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | No | no |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes | NRSI: N/A · RCT: Yes | 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 | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |