Impact of Apical Periodontitis and Non-surgical Root Canal Treatment on Serum Inflammatory Biomarkers in Patients With Cardiovascular Disease With Apical Periodontitis: A Prospective Interventional Study

Objective This study's objective was to determine the impact of apical periodontitis (AP) and non-surgical root canal treatment (NSRCT) on the levels of serum high-sensitivity C-reactive protein (hs-CRP) and cardiovascular risk in patients with cardiovascular disease (CVD). Materials and methods In this prospective interventional study, 35 patients with coronary artery disease (CAD) with AP and 35 age and gender-matched CAD without AP controls were included. In both groups, serum high-sensitivity C-reactive protein (hs-CRP) and complete hemogram (CH) indices were assessed at baseline. Root canal treatment was done in teeth with AP, and biomarkers were reassessed at 6- and 12-month follow-ups. Mann-Whitney and Wilcoxon signed-rank tests were applied for intergroup and intragroup comparison, respectively. Multiple regression models were used to predict the effect of AP on change in hs-CRP levels after NSRCT after adjusting for possible demographic oral and classic cardiovascular confounders. Results A significant difference in hs-CRP levels was observed between patients with CAD with AP [1.95 (0.13-6.34) (2.17)] and controls [1.04 (0.40-3.12) (1.30)] mg/L at baseline. At 12 months post-treatment, there was a significant reduction in hs-CRP levels to 0.55 (0.40-2.4) (0.75) mg/L, and a reduction was also observed in a number of patients classified as a high-risk group with hs-CRP levels >3 mg/L, from 26% to 0%. Conclusion Significantly higher systemic inflammatory burden (SIB) as assessed by systemic inflammatory biomarkers was observed in patients with CAD with AP than CAD without AP controls, which reduced significantly after NSRCT, highlighting the efficacy of non-surgical root canal treatment (NSRCT) in reducing SIB and hence, cardiovascular risk. Clinical relevance This is the first prospective interventional study in CVD patients to assess the impact of apical periodontitis and non-surgical root canal treatment on systemic inflammatory burden and cardiovascular risk.