Introduction
Periodontitis is an inflammatory-infectious disease caused by an imbalance between host defense mechanisms and specific periodontal pathogens and is associated with the long-term destruction of periodontal supporting tissues [1]. In this disease, gram-negative bacteria interact with the production of endotoxin in subgingival plaques by toll-like receptors (TLR) on the surface of polymorphonuclear leukocytes and monocytes. The complex, created by the interaction of endotoxins and TLR, activates the signal transduction pathway in both innate and acquired immunity, resulting in the production of cytokines that elicit local and systemic inflammatory responses. These inflammatory cytokines, which originate from the site of the disease, activate liver cells to produce acute-phase proteins (APPs) as part of a nonspecific response. APPs are a group of proteins that in response to inflammatory conditions (such as periodontal disease) the concentration of some of them increases (positive type) and the concentration of others (negative type) decreases (Table 1).



It is called the acute-phase response (APR) and occurs approximately 90 minutes after the onset of a systemic inflammatory reaction (Figure 1). Non-surgical periodontal treatment is usually the first step in the treatment process of periodontitis to eliminate its etiological agent and reduce inflammation and can change the concentration of inflammatory markers, such as APPs. The purpose of this review article was to investigate the types of APPs and the effect of inflammatory conditions in periodontitis and non-surgical periodontal treatment on them [2].



Methods
The present review was done to investigate the effect of inflammatory conditions, such as periodontal disease, and their treatment on the plasma levels of APPs. Articles were searched from 2000 to 2022 using the English keywords periodontitis, APPs, periodontal debridement, and inflammation mediators, separately and in combination. A preliminary search found 173 articles related to the effect of periodontal inflammatory disease on the level of APPs, of which 141 cases were found in Google Scholar and 32 in PubMed and Scopus. In the next step, articles were collected and initially reviewed, and studies with duplicate titles were removed. At this stage, the 56 articles had duplicate titles and were deleted. After checking the duplicates, the full text of the obtained studies was searched. Then, the abstract of the selected studies was reviewed based on the purpose of the review. Then, the final review and selection of studies based on the pre-defined inclusion and exclusion criteria were performed. These criteria included the time of publication, access to the original articles, and articles related to the effect of periodontitis and its treatment on the levels of APPs. Articles that were not in English or whose full text was not available or those that examined the effect of periodontitis on anything other than the positive type of acute-phase proteins were removed. The relevance of the articles was independently assessed by two researchers. Extraction of the required data was done using a pre-prepared checklist. Thus, another 52 articles were deleted and finally, 65 articles were selected and reviewed [1].

Results
From this review article, it can be concluded that periodontal disease as an inflammatory disease can lead to changes in the levels of APPs so that this disease leads to increased levels of these proteins and subsequently after periodontal treatment, a decrease is seen in their levels.

Discussion 
Periodontitis is an inflammatory-infectious disease of the supporting tissues around the teeth, which if left untreated, leads to long-term destruction of these supporting tissues. In addition, it can lead to local and systemic inflammatory responses and subsequently change the levels of APPs. APPs, as a group of proteins that undergo changes in serum and plasma levels in response to inflammatory conditions, are divided into positive and negative types so that in inflammatory conditions, an increase in concentration is seen in the positive type and a decrease in concentration in the negative type.
A periodontal treatment includes non-surgical treatment, which is the first step in the treatment process, and its purpose is to remove etiological factors and reduce inflammation; thus, the gold standard in periodontal non-surgical treatment is scaling and root planing. After that, periodontal surgical treatment is performed to remove local and residual factors, if needed. After periodontal treatment, the concentration of positive APPs takes a reverse trend, and serum levels of positive APPs return to normal levels.

Ethical Considerations

Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
All authors contributed equally to preaparing the article.

Conflicts of interest
The authors declared that they have no competing interests with regard to authorship and/or publication of this paper.


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