{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:43:55Z","timestamp":1790873035716,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T00:00:00Z","timestamp":1731715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To assess the available evidence on whether nonsurgical periodontal treatment (NSPT) improves arterial stiffness outcomes in patients with periodontitis (PD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following the Preferred Reporting Items for Systematic Reviews and Meta\u2010analyses (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\u2010media thickness (CIMT), and flow\u2010mediated 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\u2010analysis, and methodological index for nonrandomized studies (MINORS) and Cochrane Rob2 tools were used to assess the risk of bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen articles were finally included for qualitative synthesis. Among them, eight single\u2010arm cohort studies met the final inclusion criteria for meta\u2010analysis. 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\u2010analysis showed that NSPT significantly impacted FMD (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) and CIMT (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.004), while changes in PWV were not statistically significant. However, there was high heterogeneity among studies (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a078% for FMD and <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a062% for CIMT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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\u2010quality evidence on the effect of NSPT on arterial stiffness outcomes in PD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>PROSPERO ID CRD42024501399.<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:p>Periodontitis (PD) has been associated with alterations in arterial stiffness outcomes related to early endothelial dysfunction. Based on noninterventional studies, this meta\u2010analysis 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\u2010mediated dilatation and carotid intima\u2010media thickness, while this trend was not observed for pulse wave velocity. Moreover, the findings of the present meta\u2010analysis 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jper.24-0422","type":"journal-article","created":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T13:17:54Z","timestamp":1731763074000},"page":"330-345","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6717-8899","authenticated-orcid":false,"given":"Alessandro","family":"Polizzi","sequence":"first","affiliation":[{"name":"Department of General Surgery and Medical\u2010Surgical Specialities Unit of Periodontology, University of Catania  Catania 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