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Limited evidence shows short-term benefit of probiotics when used as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

Abstract Data sourcesMedline, Cochrane Central Register of Controlled Trials and Science Direct databases. Hand searches of the Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, Journal of Dental Researc h and reference searches of the included articles and related reviews.Study selectionTwo authors independently screened the literature to identify relevant randomised controlled trials (RCTs) on patients with chronic periodontitis (CP) treated with SRP and probiotic, SRP and placebo or SRP alone, with pocket probing depth (PPD) as the primary outcome. No minimum follow-up period was set for study inclusion.Data extraction and synthesisRisk of bias assessment was done independently using the Cochrane tool. Data were extracted using a predefined form. Weighted mean differences and 95% confidence intervals were calculated and meta-analysis conducted using fixed and random effects models.ResultsThree of the four included studies were included for meta-analysis. All three studies showed significant heterogeneity though they were rated as having low risk of bias. The number of patients ranged between 30 and 40 and follow-up duration ranged between 42 and 360 days amongst these studies. The reported primary outcomes were PPD and clinical attachment level (CAL); bleeding on probing, gingival index, gingival bleeding index, need for surgery and risk of disease progression were reported as secondary outcomes.Overall, the authors did not find a statistically significant reduction in PPD [-0.46mm, (-0.95, 0.02; p = 0.06)] in the probiotic group. However, when pockets were stratified as moderate and deep pockets, probiotic group showed significant reduction in PPD in moderate [0.18, (-0.28, -0.07; p = 0.01)] and deep pockets [-0.67, (-0.85, -0.49; p<0.001)]. The overall CAL gain [-0.42mm (-0.68, -0.16; p = 0.002)] and reduction in BOP [-14.66% (-24.49, -4.83; p = 0.003)] were significant in the probiotic group short-term.ConclusionsThe meta-analysis shows some beneficial effect of Lactobacillus reuteri with reduction of PPD especially in deep periodontal pockets, CAL gain was similar to other adjuncts.1, 2 However, studies with larger number of patients and longer-term follow-up are needed to confirm these findings.
PMID
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Authors

Mayor MeshTerms

Chronic Periodontitis

Root Planing

Keywords
Journal Title evidence-based dentistry
Publication Year Start




 
PMID- 29269825
OWN - NLM
STAT- MEDLINE
DCOM- 20180101
LR  - 20180101
IS  - 1476-5446 (Electronic)
IS  - 1462-0049 (Linking)
VI  - 18
IP  - 4
DP  - 2017 Dec 22
TI  - Limited evidence shows short-term benefit of probiotics when used as an adjunct
      to scaling and root planing in the treatment of chronic periodontitis.
PG  - 109-110
LID - 10.1038/sj.ebd.6401270 [doi]
AB  - Data sourcesMedline, Cochrane Central Register of Controlled Trials and Science
      Direct databases. Hand searches of the Journal of Clinical Periodontology,
      Journal of Periodontology, Journal of Periodontal Research, Journal of Dental
      Researc h and reference searches of the included articles and related
      reviews.Study selectionTwo authors independently screened the literature to
      identify relevant randomised controlled trials (RCTs) on patients with chronic
      periodontitis (CP) treated with SRP and probiotic, SRP and placebo or SRP alone, 
      with pocket probing depth (PPD) as the primary outcome. No minimum follow-up
      period was set for study inclusion.Data extraction and synthesisRisk of bias
      assessment was done independently using the Cochrane tool. Data were extracted
      using a predefined form. Weighted mean differences and 95% confidence intervals
      were calculated and meta-analysis conducted using fixed and random effects
      models.ResultsThree of the four included studies were included for meta-analysis.
      All three studies showed significant heterogeneity though they were rated as
      having low risk of bias. The number of patients ranged between 30 and 40 and
      follow-up duration ranged between 42 and 360 days amongst these studies. The
      reported primary outcomes were PPD and clinical attachment level (CAL); bleeding 
      on probing, gingival index, gingival bleeding index, need for surgery and risk of
      disease progression were reported as secondary outcomes.Overall, the authors did 
      not find a statistically significant reduction in PPD [-0.46mm, (-0.95, 0.02; p =
      0.06)] in the probiotic group. However, when pockets were stratified as moderate 
      and deep pockets, probiotic group showed significant reduction in PPD in moderate
      [0.18, (-0.28, -0.07; p = 0.01)] and deep pockets [-0.67, (-0.85, -0.49;
      p&lt;0.001)]. The overall CAL gain [-0.42mm (-0.68, -0.16; p = 0.002)] and reduction
      in BOP [-14.66% (-24.49, -4.83; p = 0.003)] were significant in the probiotic
      group short-term.ConclusionsThe meta-analysis shows some beneficial effect of
      Lactobacillus reuteri with reduction of PPD especially in deep periodontal
      pockets, CAL gain was similar to other adjuncts.(1, 2) However, studies with
      larger number of patients and longer-term follow-up are needed to confirm these
      findings.
FAU - Kumar, Satish
AU  - Kumar S
AD  - Department of Periodontics &amp; Preventive Dentistry, University of Pittsburgh
      School of Dental Medicine, Pittsburgh, Pennsylvania, USA.
FAU - Madurantakam, Parthasarathy
AU  - Madurantakam P
AD  - Department of General Practice, VCU School of Dentistry, Richmond, Virginia, USA.
LA  - eng
PT  - Journal Article
PT  - Comment
PL  - England
TA  - Evid Based Dent
JT  - Evidence-based dentistry
JID - 100883603
SB  - D
SB  - IM
CON - J Clin Periodontol. 2016 Jun;43(6):520-30. PMID: 26970230
MH  - *Chronic Periodontitis
MH  - Dental Scaling
MH  - Humans
MH  - Periodontal Index
MH  - Probiotics
MH  - *Root Planing
EDAT- 2017/12/23 06:00
MHDA- 2018/01/02 06:00
CRDT- 2017/12/23 06:00
PHST- 2017/12/23 06:00 [entrez]
PHST- 2017/12/23 06:00 [pubmed]
PHST- 2018/01/02 06:00 [medline]
AID - 6401270 [pii]
AID - 10.1038/sj.ebd.6401270 [doi]
PST - ppublish
SO  - Evid Based Dent. 2017 Dec 22;18(4):109-110. doi: 10.1038/sj.ebd.6401270.