Early Non-Invasive Detection of Arterial Stiffness Related to Endothelial Dysfunction in Apical Periodontitis Patients: A Systematic Review and Meta-Analysis.

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 (I2 = 84%), and absent for EFR (I2 = 0%). Evidence quality was 'low' for c-IMT and 'moderate' for EFR (GRADEpro). AP is associated with increased arterial stiffness. Trial Registration: PROSPERO: CRD420251047888.