Probiotic supplements and debridement of peri-implant mucositis: A randomized controlled trial

Abstract

Objective. The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. Materials and methods. Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays. Results. After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups. Conclusions. Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo.

Key Words:

• Cytokines
• gingival crevicular fluid
• lactobacilli
• lozenges
• subgingival bacteria

Acknowledgments

The test and the placebo products were generously supplied by BioGaia AB, Lund, Sweden. Professor Gunnar Dahlén and his staff at the oral microbiology unit, The Sahlgrenska Academy, University of Gothenburg are acknowledged for performing the microbial assays. The bioassays were partly funded by Region Halland, Sweden.

Declaration of interest: Dr Twetman has received grants for PhD-students from BioGaia AB, Sweden. The other authors have no conflicts of interest to declare.