Percorrer por autor "Azevedo, Henrique Machado"
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- The systemic impact of apical periodontitis: an integrative reviewPublication . Azevedo, Henrique Machado; Matos, Miguel AlbuquerqueObjective: This integrative review aimed to evaluate clinical evidence regarding the systemic impact of apical periodontitis (AP), particularly in relation to cardiovascular, renal, and metabolic outcomes, and to assess whether endodontic treatment (ET) can reduce systemic inflammatory burden. Methods: A comprehensive search was carried out using the databases PubMed, ScienceDirect and Web of Science, targeting clinical human studies published from 2015 to 2025. The search strategy employed predefined keyword combinations and focused on studies that assessed the relationship between AP and systemic outcomes. Eligible study designs included clinical trials, cohort studies, case-control studies and cross-sectional studies. Sixteen articles met the inclusion criteria and were analysed in accordance with the PRISMA 2020 guidelines. Results: The included studies suggest a consistent association between untreated AP and increased levels of systemic inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-α), and matrix metalloproteinases (MMPs), as well as a heightened prevalence of cardiovascular diseases (CVD) (e.g., myocardial infarction [MI], carotid atherosclerosis), type 2 diabetes mellitus (T2DM), and chronic or end-stage kidney disease (CKD/ESRD). Evidence from prospective studies indicates that successful ET can lead to significant reductions in systemic markers like asymmetric dimethylarginine (ADMA), hs-CRP, and matrix metalloproteinase 2 (MMP-2). Notably, endothelial dysfunction parameters improved at the molecular level following therapy, although not always at the functional level. Additionally, variations were observed based on sex, baseline inflammatory status, and microbial profiles. Conclusion: These results reinforce the idea that AP acts as a chronic inflammatory stimulus with potential systemic repercussions, particularly in individuals with pre-existing systemic diseases. While causality cannot yet be confirmed due to the predominance of observational study designs and heterogeneity among studies, this review highlights the importance of early detection and management of AP, even in asymptomatic cases, as part of a broader strategy to reduce systemic inflammation and promote overall health. Further randomised and mechanistic studies are needed to clarify the causative role of AP in chronic systemic disease pathways and to substantiate the long-term systemic benefits of endodontic intervention.