SYSTEMATIC REVIEW article
Front. Oral Health
Sec. Oral Epidemiology
This article is part of the Research TopicSystematic Reviews, Scoping Reviews and Evidence-Based DentistryView all 9 articles
Association of Torque Teno Virus in Periodontitis: A Systematic Review, Meta-analysis, and Trial Sequential Analysis
Provisionally accepted
Luis Alberto Chauca Bajaña1
Mario Perez Sayans2,3,4*
Alejandro Ismael Lorenso-Pouso3
Byron Velasquez Ron5Rafael Xavier Erazo Vaca6Rolando Fabricio Dau Villafuerte6Veronica Natalia Hidalgo6Jossue Tarquino Narvaez Guerrero6Cesar Humberto Palacios Jurado6Mercedes Treviño Castellano7Andrea Ordoñez Balladares6,8- 1University of Guayaquil, Guayaquil, Ecuador
- 2Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- 3Universidade de Santiago de Compostela Facultade de Medicina e Odontoloxia, Santiago de Compostela, Spain
- 4Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- 5Universidad de Las Americas, Quito, Ecuador
- 6Universidad de Guayaquil, Guayaquil, Ecuador
- 7Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- 8Universidad Bolivariana del Ecuador, Duran, Ecuador
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Background: Periodontitis, affecting 38.5% of adults globally with moderate-to-severe forms, represents a multifactorial inflammatory disease traditionally attributed to bacterial pathogens. Emerging evidence implicates viral cofactors, particularly Torque Teno virus (TTV), a ubiquitous anellovirus with 30-95% prevalence in healthy populations. Objective: To evaluate TTV prevalence in periodontitis patients versus controls through systematic review and meta-analysis. Methods: Following PRISMA guidelines, we searched multiple databases (2000-2024) for observational studies reporting TTV detection in oral samples using molecular techniques. Random-effects meta-analysis calculated pooled relative risk (RR) with 95% confidence intervals. Trial Sequential Analysis assessed evidence sufficiency. Results: Four studies encompassed 583 participants (300 periodontitis, 283 controls). Meta-analysis revealed significant TTV-periodontitis association (RR=1.67; 95%CI: 1.28-2.17; p<0.001), indicating 67% increased TTV likelihood in periodontitis patients. Heterogeneity was minimal (I²=0%) with no publication bias detected. Trial Sequential Analysis showed current evidence represents only 31.6% of required information size (1,847 participants), suggesting preliminary findings requiring validation. Conclusion: Despite consistent TTV-periodontitis association across studies, evidence remains insufficient for definitive conclusions. Larger prospective investigations using standardized diagnostic criteria are essential to establish causality and clinical significance. Registration: PROSPERO CRD420251127439
Keywords: Torque teno virus, Periodontitis, virome, Molecular diagnostics, Meta-analysis
Received: 28 Sep 2025; Accepted: 31 Oct 2025.
Copyright: © 2025 Alberto Chauca Bajaña, Perez Sayans, Lorenso-Pouso, Velasquez Ron, Erazo Vaca, Dau Villafuerte, Hidalgo, Narvaez Guerrero, Palacios Jurado, Treviño Castellano and Ordoñez Balladares. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mario Perez Sayans, mario.perez@usc.es
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