BackgroundTo 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.ResultsFifteen 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).ConclusionDespite 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.

中文翻译：

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非手术牙周治疗对内皮功能障碍相关动脉僵硬结局的影响：系统评价和荟萃分析


背景评估非手术牙周治疗 （NSPT） 是否能改善牙周炎 （PD） 患者动脉僵硬结局的现有证据。方法遵循系统评价和荟萃分析首选报告项目 （PRISMA） 指南和人群、干预、比较、结果和研究设计 （PICOS） 问题，筛选电子数据库用于临床干预研究，以解决 NSPT 对脉搏波速度 （PWV）、颈动脉内膜中层厚度 （CIMT） 的影响和 PD 患者血流介导的扩张 （FMD） 结局。此外，研究策略是使用手动搜索实现的。选择研究，并由两名独立评价员提取资料。应用随机效应模型进行荟萃分析，并使用非随机研究方法学指数 （MINORS） 和 Cochrane Rob2 工具评估偏倚风险。结果最终纳入 15 篇文献进行定性综合。其中，8 项单臂队列研究符合 meta 分析的最终纳入标准。Rob2 分析证明，一项随机临床试验 （RCT） 风险较低，三项 RCT 引起了一些担忧，三项 RCT 具有高偏倚风险，而 MINORS 评分为 9 至 14。荟萃分析显示，NSPT 显着影响 FMD （p < 0.001） 和 CIMT （p = 0.004），而 PWV 的变化没有统计学意义。然而，研究之间存在高度异质性 （FMD 的 I2 = 78%，CIMT 的 I2 = 62%）。结论尽管对 FMD 和 CIMT 有一些有益影响，但由于研究局限性、高异质性和偏倚风险，不能得出 NSPT 可有效改善动脉硬度的结论。 因此，需要进一步的研究来获得关于 NSPT 对 PD 患者动脉硬度结果影响的高质量证据。试验注册PROSPERO ID CRD42024501399。通俗易懂的语言摘要牙周炎 （PD） 与早期内皮功能障碍相关的动脉硬度结果的改变有关。基于非干预性研究，该荟萃分析表明，非手术牙周治疗 （NSPT） 可能会降低 PD 患者的心血管疾病风险。来自最终纳入的研究的中等证据表明，NSPT 对血流介导的扩张和颈动脉内膜中层厚度有有益影响，而脉搏波速度未观察到这种趋势。此外，本荟萃分析的结果具有高度异质性和偏倚风险的特点，并且来自非对照临床试验或具有局限性的随机临床试验。因此，需要更多具有标准化方案和均匀动脉硬度结局的研究来提高现有证据的质量。