Does endodontic treatment modify serum inflammatory markers of cardiovascular risk in individuals with asymptomatic apical periodontitis? a systematic review and meta-analysis

Abstract

Objective: Plasma inflammatory biomarkers linked to cardiovascular risk have been associated with asymptomatic apical periodontitis. However, it remains unclear whether endodontic treatment can reverse these alterations. This review evaluated the effect of endodontic treatment on inflammatory markers in individuals with asymptomatic apical periodontitis. Materials and methods: A comprehensive search was conducted in PubMed/Medline, Embase, Web of Science, Scopus, VHL, gray literature, and reference lists between October and November 2022, with an update in September 2025. Risk of bias was assessed using the Newcastle–Ottawa Scale, and the certainty of evidence using the GRADE approach. Random-effects meta-analysis estimated pooled mean differences (MD) and 95% confidence intervals (95%CI) for serum inflammatory markers concentrations between treated individuals and controls (α = 5%). Results: The search identified 6,295 records; sixteen studies were assessed and eight included in the quantitative synthesis. All studies showed moderate risk of bias, and evidence certainty was very low. Meta-analysis suggested possible reductions in C-reactive protein (CRP) [MD = 0.76 (95% CI: − 0.15, 1.67)], interleukin-6 (IL-6) [MD = 0.81 (95% CI:–0.27, 1.90)], and tumor necrosis factor-alpha (TNF-α) [MD = 1.04 (95% CI:–0.38, 2.46)] after endodontic treatment, with levels similar to control groups. Conclusion: Evidence, although limited, suggests endodontic treatment may lower serum CRP, IL-6, and TNF-α levels in asymptomatic apical periodontitis patients. Clinical relevance: Endodontic treatment of asymptomatic apical periodontitis may help reduce systemic inflammatory biomarkers associated with cardiovascular risk, reinforcing its potential role beyond local infection control.