Role of human cytomegalovirus in the pathogenesis of periapical lesions - A systematic review and meta-analysis.

BACKGROUND

Viruses, especially those of the Herpesviridae family, are increasingly linked to the pathogenesis of periapical lesions. Human cytomegalovirus (CMV), capable of lifelong latency and reactivation under stress or infection, can enhance proinflammatory cytokine release, stimulate osteoclast activity, and drive tissue destruction.

OBJECTIVE

To evaluate the prevalence of CMV DNA and/or RNA in periapical lesions and to evaluate its potential role in their pathogenesis.

MATERIALS AND

METHODS

A comprehensive search was performed using MEDLINE via PubMed, Google Scholar, Scopus, and ResearchGate up to April 2025, following PRISMA guidelines. Original studies that explored the role of CMV in periapical lesions were included. The risk of bias was evaluated with the modified Newcastle-Ottawa Scale, with results generated in Review Manager 5.4. Meta-analyses were carried out using OpenMeta Analyst.

RESULTS

Thirty-one studies were included for qualitative analysis, of which 17 met eligibility for meta-analysis. The pooled prevalence of CMV in periapical lesions was 28 % (95 % CI: 17 %-40 %). Symptomatic lesions showed significantly higher CMV detection compared to asymptomatic cases (OR = 2.67, 95 % CI: 1.44-4.95). Subgroup analysis showed that CMV prevalence varied by detection method, with higher estimates using RT-PCR, indicating assay sensitivity as a major source of heterogeneity.

CONCLUSION

This review highlights that CMV was significantly associated with symptomatic and larger periapical lesions, likely contributing to disease progression via immune modulation, cytokine induction, and viral-bacterial interactions. Further research is warranted to clarify its pathogenic role and explore antiviral strategies in endodontic management.