The effectiveness of probiotics as an adjunct to non-surgical periodontal therapy

Abstract

There has been a growing interest in the use of probiotics in the management of periodontal diseases. There is ‘some’ evidence of the benefits of probiotics; at least in the short term, with respect to some markers of periodontal diseases. A systematic review and meta-analyses were undertaken to determine the effectiveness of probiotics in the management of periodontal diseases in the longer term and with respect to a range of clinical, microbiological and immunological attributes (PROSPERO Reg. no.: CRD42018092851). Electronic searches of five databases were performed for qualitative and quantitative syntheses of studies that compared the adjunctive use of probiotics in conjunction with non-surgical periodontal therapy (NSPT). The search yielded 5,452 publications across the 5 databases; 2,189 remained after removal of duplicate references. After screening, 13 ‘potentially effective’ studies were identified (K 0.799). Following full-text assessments, 10 studies informed the systematic review (K 1.000). With respect to CAL, meta-analyses identified the Mean Difference (MD) to be 0.18mm (95%CI 0.03, 0.33) at 3-months, 0.31mm (95%CI -0.20, 0.82) at 6-months, -0.01mm (95%CI -0.34, 0.32) at 9-months and 0.90mm (95%CI 0.79, 1.02) at 12-months. With respect to PPD, the MD was -0.21mm (95%CI -0.39, -0.03) at 3-months, -0.40mm (95%CI -0.98, 0.18) at 6-months, -0.06mm (95%CI -0.30, 0.17) at 9-months and -1.16mm (95%CI -1.32, -0.99) at 12-months. With respect to microbiological outcomes no significant MD were observed for the four key periodontal pathogens (Pg, Tf, Pi, Fn) at 3-months. Qualitative analyses identified no significant difference in immunological markers (GCF volume, MMP-8 and TIMP-1). The systematic review found evidence to support the effectiveness of probiotics as an adjunct to NSPT - in terms of improvements in CAL and PPD at 3-months and 12-months but not at 6-months or 9-months. No significant benefits in terms of microbiological or immunological outcomes were apparent. Further clinical trials of high quality are required.

Subsequently, a double-blind, paralleled-arm, placebo-controlled, randomized clinical trial was conducted to evaluate the clinical effectiveness of the probiotics Lactobacillus reuteri as an adjunct to NSPT. Probiotics or placebo lozenges were randomly prescribed for use twice-daily for 28 days. Primary outcomes were clinical attachment levels (CAL) and probing pocket depths (PPD). All participants underwent NSPT and follow-up clinical assessments were performed at Day 90 and Day 180. The trial’s response rate was 69.5% (41 out of 59). Among the test and control groups, there were significant intra-group differences in primary outcomes: CAL (both, p<0.001)

and PPD (both, p<0.001); and in secondary outcomes: percentage of sites with ‘bleeding on probing’ (both, p<0.001) and ‘visible plaque’ (both, p<0.001). No statistically significant inter-group differences in any outcomes at any time points (all, p>0.05) nor in the changes in outcomes (∆) with time (all, p>0.05). There was a trend of a greater magnitude of statistical change occurring among the test group compared to the control group. The adjunctive use of probiotics with NSPT did not show ‘any additional’ clinical effectiveness when compared to NSPT alone in the management of periodontitis (ChiCTR-IOR-17010526).