Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta-analysis

Background To assess the available evidence on whether nonsurgical periodontal treatment (NSPT) improves arterial stiffness outcomes in patients with periodontitis (PD). MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and population, intervention, comparison, outcomes, and study design (PICOS) question, electronic databases were screened for clinical interventional studies addressing the impact of NSPT on pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) outcomes in PD patients. Furthermore, the research strategy was implemented using a hand search. Studies were selected, and data were extracted by two independent reviewers. Random effects models were applied to perform a meta-analysis, and methodological index for nonrandomized studies (MINORS) and Cochrane Rob2 tools were used to assess the risk of bias. Results Fifteen articles were finally included for qualitative synthesis. Among them, eight single-arm cohort studies met the final inclusion criteria for meta-analysis. The Rob2 analysis evidenced that one randomized clinical trial (RCT) had a low risk, three RCTs raised some concerns, and three RCTs had a high risk of bias, while the MINORS scores ranged from 9 to 14. The meta-analysis showed that NSPT significantly impacted FMD (p < 0.001) and CIMT (p = 0.004), while changes in PWV were not statistically significant. However, there was high heterogeneity among studies (I2 = 78% for FMD and I2 = 62% for CIMT). Conclusion Despite some beneficial effects on FMD and CIMT, due to study limitations, high heterogeneity, and risk of bias, it cannot be concluded that NSPT is effective in improving arterial stiffness. Therefore, further studies are necessary to achieve high-quality evidence on the effect of NSPT on arterial stiffness outcomes in PD patients. Trial registrationPROSPERO ID CRD42024501399. Plain Language SummaryPeriodontitis (PD) has been associated with alterations in arterial stiffness outcomes related to early endothelial dysfunction. Based on noninterventional studies, this meta-analysis indicates that nonsurgical periodontal treatment (NSPT) may reduce cardiovascular disease risk in patients with PD. The moderate evidence derived from the studies that were finally included showed that NSPT had beneficial effects on flow-mediated dilatation and carotid intima-media thickness, while this trend was not observed for pulse wave velocity. Moreover, the findings of the present meta-analysis were characterized by high heterogeneity and risk of bias and were derived from uncontrolled clinical trials or randomized clinical trials with limitations. Therefore, more studies with standardized protocols and homogeneous arterial stiffness outcomes are needed to elevate the quality of the present evidence.