OBJECTIVES The purpose of this systematic review was to examine if, in adult patients, the absence or presence of smoking influenced the prevalence of periapical periodontitis (PP). MATERIALS AND METHODS Databases were searched, and original research manuscripts up to June 2019 were identified by two reviewers. The Newcastle-Ottawa Scale (NOS) was used for risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. A meta-analysis was performed using RevMan 5 software. Risk ratio (RR) was used for the cohort studies, and odds ratio (OR) was used for the case-control studies with 95% confidence interval (CI). RESULTS All the studies had many covariates and confounding variables. Three longitudinal cohort articles discussed radiographic findings as they related to the prevalence of PP in root-filled teeth. The RR of smoking and the prevalence of PP was 2.11 (95% CI 0.88-5.05, p = 0.09). Nine case-control studies focused on the prevalence of PP and smoking. There was a positive association between smoking and the prevalence of PP with an OR of 2.78 and a 95% confidence interval of 2.23-3.48, with p value < 0.05. The quality of the studies was fair per NOS, and the certainty of the literature assessment was moderate per GRADE. CONCLUSIONS The current best available evidence suggests that smoking was associated with the prevalence of PP but more studies are needed to report this association in the longitudinal cohort studies. CLINICAL RELEVANCE Smoking has a positive association with the prevalence of PP.

中文翻译：

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吸烟与根尖周周炎之间的关联：系统评价。

目的本系统评价的目的是检查在成年患者中是否吸烟是否影响根尖周炎（PP）的患病率。材料和方法检索数据库，并由两名审稿人确定截至2019年6月的原始研究手稿。纽卡斯尔-渥太华量表（NOS）用于偏倚风险。建议，评估，制定和评估的分级（GRADE）系统用于确定证据。使用RevMan 5软件进行荟萃分析。队列研究使用风险比（RR），病例对照研究使用比值比（OR），置信区间（CI）为95％。结果所有研究都有许多协变量和混杂变量。三篇纵向队列文章讨论了影像学发现，因为它们与牙根充填牙齿中的PP患病率有关。吸烟的RR和PP的患病率为2.11（95％CI 0.88-5.05，p = 0.09）。九项病例对照研究的重点是PP和吸烟的患病率。吸烟与PP患病率呈正相关，OR为2.78，95％置信区间为2.23-3.48，p值<0.05。每个NOS的研究质量是公平的，每个GRADE的文献评估的确定性是中等的。结论当前最好的证据表明吸烟与PP的患病率有关，但在纵向队列研究中需要更多的研究来报告这种关系。临床相关性吸烟与PP的流行呈正相关。