Periodontitis treatment and progression of carotid intima-media thickness: a randomized trial

Abstract Background and Aims Intensive periodontal treatment (IPT) improves endothelial function in patients with periodontitis (PD). However, whether these changes can slow the progression of structural vascular remodelling remains unclear. This randomized clinical trial evaluated the impact of IPT on carotid intima-media thickness (cIMT) over 2 years (NCT03072342). Flow-mediated dilatation (FMD), blood pressure and pulse wave velocity (PWV) were assessed as secondary outcomes, while markers of inflammation, oxidative stress, and metabolomics were explanatory outcomes. Methods 135 consecutive, otherwise healthy participants with PD, were enrolled in a single-blind, single-centre, controlled trial, and randomized to IPT (n = 68; including scaling, root planning, and, when appropriate, surgical corrective therapy) or control periodontal treatment (CPT, n = 67; including supra-gingival scaling and polishing). cIMT was assessed at baseline, 12 and 24 months post-therapy. Blood pressure, FMD, PWV, markers of inflammation, oxidative stress, and metabolomics were assessed at baseline and at 2, 6, 12, 18, and 24 months post-intervention. Results After 24 months, cIMT was lower in the IPT vs the CPT group (−0.023 mm, 95% confidence interval −0.030.019 to −0.0227, P < 0.0001). FMD improved within 2 months in the IPT group and remained consistently higher than the CPT group throughout the study (P < 0.0001) correlating with the improved periodontal measurements at the same time points. No substantial differences were observed between groups in adverse events, anthropometric, blood pressure, PWV, or metabolomic markers. Among inflammatory and oxidative stress markers, glycoprotein acetyl was reduced in IPT compared with the CPT group participants (P < 0.05). Conclusions IPT led to favourable structural changes in the vascular phenotype, underscoring the impact of PD on cardiovascular health and further highlighting the potential role of treating PD to improve cardiovascular outcomes.