***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM This study aim ed to compare the effect of single-visit full-mouth mechanical debridement ( FMD ) and quadrant-wise mechanical debridement ( QMD ) on the levels of serum interleukin (IL)-6 , C-reactive protein ( CRP ) and soluble thrombomodulin . MATERIAL AND METHODS Thirty-six subjects with chronic periodontitis were r and omly allocated to three groups : undergoing QMD , single-visit FMD with povidone iodine or with water .  Serum IL-6 and soluble thrombomodulin were measured by enzyme-linked immunosorbent assay , and serum CRP was measured by the latex-enhanced nephelometric method . RESULTS Serum IL-6 level increased significantly immediately after debridement in all the three groups , with this increase being greatest in the full-mouth groups . However , the increase in the full-mouth groups was not significantly higher than that of quadrant-wise group . In the quadrant-wise group , serum IL-6 level decreased significantly 1 month after debridement compared with baseline . Serum-soluble thrombomodulin decreased significantly in the full-mouth groups but not in the quadrant-wise group . Changes in CRP level were not significant at baseline or after debridement in all the three groups . CONCLUSIONS FMD increased serum IL-6 and reduced serum-soluble thrombomodulin to a greater extent than QMD , suggesting that the former technique has stronger transient effects on systemic vascular endothelial functions than the latter Background Periodontal disease ( PD ) is an infectious clinical entity characterized by the destruction of supporting tissues of the teeth as the result of a chronic inflammatory response in a susceptible host . It has been proposed that PD as sub clinical infection may contribute to the etiology and to the pathogenesis of several systemic diseases including Atherosclerosis . A number of epidemiological studies link periodontal disease/edentulism as independent risk factor for acute myocardial infa rct ion , peripheral vascular disease , and cerebrovascular disease . Moreover , new r and omized controlled clinical trials have shown an improvement on cardiovascular surrogate markers ( endothelial function , sICAM , hsPCR level , fibrinogen ) after periodontal treatment . Nonetheless , such trials are still limited in terms of external validity , periodontal treatment strategies , CONSORT-based design and results consistency/extrapolation . The current study is design ed to evaluate if periodontal treatment with scaling and root planning plus local delivered chlorhexidine improves endothelial function and other biomarkers of cardiovascular disease in subjects with moderate to severe periodontitis . Methods / Design This r and omized , single-blind clinical trial will be performed at two health centers and will include two periodontal treatment strategies . After medical/periodontal screening , a baseline endothelium-dependent brachial artery flow-mediated dilatation ( FMD ) and other systemic surrogate markers will be obtained from all recruited subjects . Patients then will be r and omized to receive either supragingival/subgingival plaque cleaning and calculus removal plus chlorhexidine ( treatment group ) or supragingival plaque removal only ( control group ) . A second and third FMD will be obtained after 24 hours and 12 weeks in both treatment arms . Each group will consist of 49 patients ( n = 98 ) and all patients will be followed-up for secondary outcomes and will be monitored through a coordinating center . The primary outcomes are FMD differences baseline , 24 hours and 3 months after treatment . The secondary outcomes are differences in C-reactive protein ( hs-CRP ) , glucose serum levels , blood lipid profile , and HOMA index . Discussion This RCT is expected to provide more evidence on the effects of different periodontal treatment modalities on FMD values , as well as to correlate such findings with different surrogate markers of systemic inflammation with cardiovascular effects . Trial registration number Clinical Trials.gov Identifier : NCT00681564 Much work has been published on the association between periodontal disease and systemic disease , including original reports , narrative review s , systematic review s , and meta-analyses . Based on the existent work , one can assign an evidence level and grade , using st and ard evidence -based criteria , to the data available in the four major categories of medical outcomes studied : cardiovascular/cerebrovascular , pregnancy , pulmonary , and diabetes . We discuss method ologic and conceptual problems in the study of oral-systemic associations , focusing as an example on the association between periodontal disease and cardiovascular/cerebrovascular disease . We argue that the hierarchical ranking of studies by levels of evidence may be misleading . In particular , while r and omized controlled trials ( RCTs ) are needed to determine the efficacy of periodontal treatment to reduce the risk of cardiovascular events , they may be of limited value in determining the etiologic role of periodontal disease on coronary heart disease and stroke . We discuss limitations of RCTs as well as the limitations of currently available data from epidemiologic studies , including study design and confounding and misclassification errors . We conclude that well- design ed observational studies into the associations between periodontal disease and systemic disease need to remain an integral component of future research efforts in order to fully underst and such associations BACKGROUND Rheumatoid arthritis ( RA ) and periodontitis are common chronic inflammatory conditions . Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA . This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha ( anti-TNF-alpha ) medications .  The effect of anti-TNF-alpha therapy on periodontitis also was assessed . METHODS Forty participants diagnosed with moderate/severe RA ( under treatment for RA ) and severe periodontitis were r and omly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions ( n = 20 ) or no periodontal therapy ( n = 20 ) . To control RA , all participants had been using disease-modifying anti-rheumatic drugs  , and 20 had also been using anti-TNF-alpha  before r and omization . Probing depth ( PD ) , clinical attachment level ( CAL ) , bleeding on probing ( BOP ) , gingival index ( GI ) , plaque index ( PI ) , RA disease activity score 28 ( DAS28 ) , and erythrocyte sedimentation rate ( ESR ) were measured at baseline and 6 weeks later . Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not . RESULTS Patients receiving periodontal treatment showed a significant decrease in the mean DAS28 , ESR ( P < 0.001 ) , and serum TNF-alpha ( P < 0.05 ) . There was no statistically significant decrease in these parameters in patients not receiving periodontal treatment . Anti-TNF-alpha therapy result ed in a significant improvement in CAL , PD , BOP , and GI . CONCLUSIONS Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA , regardless of the medications used to treat this condition . Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition BACKGROUND Chronic infections , such as periodontitis , are associated with increased risk of systemic diseases driven by a persistent low- grade systemic inflammation and metabolic changes . Severity of periodontitis has also been associated with increased systolic blood pressure ( BP ) . However , the issue remains poorly investigated . We aim ed to estimate the effect of periodontal therapy on traditional and novel cardiovascular risk factors in systemically healthy individuals who have periodontitis . METHODS We enrolled 40 otherwise healthy patients with severe chronic generalized periodontitis in a 6-month pilot intervention trial . Individuals were r and omized either to a st and ard course of periodontal therapy ( subgingival scaling and root planing ) or an intensive one ( including the adjunctive use of a locally delivered antimicrobial , IPT ) . RESULTS Compared to control , IPT produced significant reductions in a cluster of inflammatory markers at 1 ( P = .0406 ) and 2 ( P = .0060 ) months together with an improvement in lipid markers at 2 ( P = .0320 ) and 6 ( P = .0432 ) months after therapy . Intensive periodontal therapy produced greater reductions in IL-6 at 1 ( 0.4 + /- 0.2 ng/L difference , 95 % CI 0.03 - 0.9 , P = .0284 ) and 2 months ( 0.3 + /- 0.2 ng/L difference , 95 % CI 0.1 - 0.8 , P = .0284 ) , together with decreases in C-reactive protein ( 0.4 + /- 0.2 mg/L difference , 95 % CI 0.01 - 0.8 , P = .0438 ) and total cholesterol ( 0.3 + /- 0.1 mmol/L difference , 95 % CI 0.04 - 0.6 , P = .0254 ) . Moreover , a 7 + /- 3-mm Hg decrease in systolic BP was observed at 2 months in the IPT group ( 95 % CI 1 - 12 , P = .0211 ) , and this difference was greater in current smokers ( 14 + /- 5 mm Hg 95 % CI 3 - 25 , P = 0.0124 ) . Intensive periodontal therapy subjects exhibited a 1.53 % + /- 1.20 % ( 95 % CI 1.05 - 2.24 , P = .0290 ) and 2.00 % + /- 1.42 % ( 95 % CI 0.98 - 4.09 , P = .0568 ) decreases in cardiovascular risk scores ( Framingham ) at 2 and 6 months , respectively , when compared to those in the st and ard group . CONCLUSIONS Our findings suggest that intensive periodontal treatment  reduces systemic inflammatory markers and systolic BP , and improves lipid profiles with subsequent changes in cardiovascular risk when compared to st and ard therapy AIM We studied the effect of atorvastatin ( ATV ) treatment on bone loss prevention in subjects with chronic periodontitis . MATERIAL AND METHODS In this controlled double-blind study , 38 subjects with chronic periodontitis were r and omized into two groups , paired by age to receive ATV ( 20 mg ) or placebo daily for 3 months . Periodontal mechanical treatment was carried out in both groups at baseline . Clinical and radiographic parameters and bone turnover markers were assessed at baseline and at 3 months . RESULTS Periodontal disease conditions improved in both groups . After comparing the figures of change , significant improvements were observed in cholesterol levels ( Δ=-58.5 ± 37.6 versusΔ=5.4 ± 41.2 mg/dl , p<0.0002 ) , low-density lipoprotein levels ( Δ=-48.1 ± 31.7 versusΔ=1.9 ± 42.8 mg/dl , p<0.002 ) , dental mobility ( Δ=-0.17 ± 0.11 versusΔ=-0.06 ± 0.11 % , p<0.04 ) , and the distance from the crestal alveolar bone to the cemento-enamel junction ( Δ=-0.75 ± 0.7 versusΔ=0.09 ± 0.4 mm , p<0.0006 ) in the ATV group . CONCLUSIONS The results suggest that ATV might have beneficial effects on bone alveolar loss and tooth mobility in subjects with periodontal disease BACKGROUND The present r and omized , double-masked , placebo-controlled , parallel-arm study examines the impact of adjunctive subantimicrobial-dose doxycycline ( SDD ) on the local inflammatory response through cytokine and chemokine levels in gingival crevicular fluid ( GCF ) sample s from patients with chronic periodontitis . METHODS Forty-six patients with chronic periodontitis received scaling and root planing with or without adjunctive SDD . GCF sample s were collected and clinical parameters including probing depth , clinical attachment level , gingival index , and plaque index were recorded every 3 months for 12 months . GCF tumor necrosis factor-α , interleukin (IL)-6 , IL-4 , IL-10 , IL-13 , IL-17 , macrophage inhibitory protein 1α , macrophage inhibitory protein 1β , monocyte chemoattractant protein 1 , and regulated on activated normal T-cell expressed and secreted protein levels were determined by xMAP multiplex immunoassay . RESULTS Significant improvements were observed in all clinical parameters in both groups over 12 months ( P < 0.0125 ) , whereas the SDD group showed significantly better reduction in gingival index , probing depth , and gain in clinical attachment compared to the placebo group ( P < 0.05 ) . Decrease in IL-6 in the SDD group was significantly higher compared to the placebo group at 6 and 9 months in deep pockets ( P < 0.05 ) , whereas tumor necrosis factor-α was significantly reduced in moderately deep pockets ( P < 0.05 ) . SDD result ed in a stable IL-4 and IL-10 response while reducing the monocyte chemoattractant protein 1 levels at 3 months ( P < 0.05 ) . CONCLUSIONS These results show that SDD , as an 
    Output:
    
AUTHORS ' CONCLUSIONS We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis .
No evidence on primary prevention was found