Apical periodontitis was significantly associated with increased carotid intima-media thickness (MD 0.16 mm; 95% CI 0.02-0.30; p=0.01) and reduced endothelial flow reserve.
Meta-Analysis
Is apical periodontitis associated with increased non-invasive markers of arterial stiffness in systemically healthy individuals?
Apical periodontitis is associated with increased arterial stiffness and endothelial dysfunction in systemically healthy individuals, suggesting a potential link to cardiovascular risk.
Effect estimate: MD 0.16 mm (c-IMT); MD -0.30 (EFR) (95% CI 0.02-0.30 (c-IMT); -0.43 to -0.16 (EFR))
p-value: p=0.01 (c-IMT); <0.0001 (EFR)
ABSTRACT This systematic review and meta‐analysis evaluated the association between apical periodontitis (AP) and non‐invasive markers of arterial stiffness, including carotid intima‐media thickness (c‐IMT), endothelial flow reserve (EFR), flow mediated dilatation (FMD), carotid plaques and aortic atherosclerotic burden (AAB) in systemically healthy individuals. PubMed/MEDLINE, Cochrane, Scopus and EMBASE were searched. Quality assessment was done using the Newcastle‐Ottawa Scale. Six studies were selected, with two at low and four at moderate risk of bias. Five studies (two c‐IMT; three EFR) underwent meta‐analysis. Pooled analysis demonstrated that AP was significantly associated with increased c‐IMT (mean difference: 0.16 mm; 95% CI: 0.02–0.30; p = 0.01) and reduced EFR (mean difference: −0.30; 95% CI: −0.43 to −0.16; p < 0.0001). Heterogeneity was high for c‐IMT ( I 2 = 84%), and absent for EFR ( I 2 = 0%). Evidence quality was ‘low’ for c‐IMT and ‘moderate’ for EFR (GRADEpro). AP is associated with increased arterial stiffness. Trial Registration: PROSPERO: CRD420251047888
Chauhan et al. (2026) conducted a meta-analysis in Apical periodontitis. Apical periodontitis was evaluated on Non-invasive markers of arterial stiffness (c-IMT and EFR) (MD 0.16 mm (c-IMT); MD -0.30 (EFR), 95% CI 0.02-0.30 (c-IMT); -0.43 to -0.16 (EFR), p=0.01 (c-IMT); <0.0001 (EFR)). Apical periodontitis was significantly associated with increased carotid intima-media thickness (MD 0.16 mm; 95% CI 0.02-0.30; p=0.01) and reduced endothelial flow reserve.