• periodontitis
• acute inflammation
• C-reactive protein
• hypertension
• obesity

Aim. The study aimed to evaluate acute perturbations of systemic inflammation after non-surgical periodontal treatment by comparing two different protocols, Quadrant Scaling and Root Planning (Q-SRP) versus Full-Mouth Scaling and Root Planning (FM-SRP) in hypertensive and obese patients, respectively.
Methods. Two trials were performed; 80 patients affected by periodontitis, of those 40 patients with hypertension and 40 obese patients, were randomly allocated to either FM-SRP or Q-SRP, respectively. Periodontal parameters were collected at baseline and after 3-months. Vital signs, endothelial function exam, and blood collection were performed at baseline, 24-hours after the first session of treatment and at 3-months control. High sensitivity assays of inflammatory and glucose-related biomarkers and lipids were performed on all samples.
Results. Periodontal treatment was successful in both trials independently of the treatment group allocation. A significantly higher increase in hs-CRP levels was observed one day after the FM-SRP treatment approach compared to the Q-SRP approach in both, hypertensive and obese patients, respectively (p<0.05 for both trials). Moreover, intragroup changes in IL-6 levels were observed in both treatment groups in the Hypertension trial (p<0.01) and in the FM-SRP group in the Obesity trial (p<0.01). In hypertensive individuals, a significant reduction in systolic blood pressure (BP) and diastolic BP was observed in the Q-SRP group (p<0.01) and a reduction in systolic BP in the FM-SRP group (p<0.05). In obese subjects, a reduction in HbA1c and insulin levels were observed at 3-months (p<0.05 and p<0.01, respectively) in the Q-SRP group, whereas in the FM-SRP group a reduction in insulin level was observed at 3-months (p<0.01). Multivariate regression models revealed that high body mass index (BMI), FM-SRP approach, age>60 years, smoking, and high systolic BP levels are negative predictive factors for HbA1c increase 3-months after treatment in obese patients. Similarly, in hypertensive patients, negative predictive factors for systolic BP increase at 3- months are relative hs-CRP increase at Day 1, FM-SRP approach, age>60 years, smoking, and high levels of HbA1c. Intragroup reduction in total OHIP-14 score was observed for both treatment groups in the obese population, and in the Q-SRP group in the Hypertension trial.
Conclusions. In conclusion, to avoid acute systemic perturbations, it is recommended to divide non-surgical periodontal treatment according to a conventional treatment protocol in patients with comorbidities, such as hypertension and obesity, to minimize potential risk for cardiovascular events and/or metabolic disruptions.