Adjunctive probiotics after periodontal debridement versus placebo: a systematic review and meta-analysis

Abstract

Objective

To comprehensively investigate the efficacy of adjunctive probiotics compared to placebo, using conventional and novel treatment outcomes.

Materials and methods

Three databases (MEDLINE, EMBASE, and CENTRAL) were searched. Outcomes included percent change in the total number of deep sites before and after therapy, change in mean probing pocket depth (mm), percentage patients requiring additional therapy, risk for disease progression, and microbiological and immunological results. Meta-analysis was conducted to evaluate treatment effects wherever appropriate.

Results

Ten studies were selected from 818 records. Meta-analysis showed that adjunctive probiotics had no additional benefit for percentage change of the total number of deeper sites (≥5 mm, ≥6 mm, ≥7 mm) before and after therapy. No significant difference was observed for mean probing pocket depth reduction at 3 and 6 months. Statistically significant beneficial odds ratios for need for additional therapy (OR = 0.19, 95% CI [0.07–0.56]) and risk of disease progression (OR = 0.32, 95% CI [0.14–0.73]) were observed with probiotic administration. Immunological rather than microbiological outcomes correlated more consistently with clinical findings. No adverse events were reported.

Conclusions

Adjunctive probiotics are safe in systemically healthy individuals and could offer additional patient-level benefits compared to placebo, hence its use can sometimes be justified.

Keywords:

• Lactobacillus
• Bifidobacterium
• periodontitis
• periodontal debridement
• host-modulation

Acknowledgements

The authors would like to thank Professor Philip Mulligan Preshaw for his invaluable advice throughout the course of this study.

Disclosure statement

This study was self-funded by the authors. No potential competing interest was reported by the authors.

Author contributions

EN contributed to conception, design, data acquisition and interpretation, and drafted and critically revised the manuscript. JT contributed to conception, design, data acquisition and interpretation, and critically revised the manuscript. SS contributed to data acquisition, analysis, and interpretation. LL, CK, and MO contributed to data interpretation and critically revised the manuscript. All authors gave their final approval and agreed to be accountable for all aspects of the work.