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JADA+ Clinical Scan: Probiotics as adjuvant to scaling and root planing seem to improve periodontal parameters after 3 months of treatment

June 19, 2017

By Romina Brignardello-Petersen, DDS, MSc, PhD


DOI: http://dx.doi.org/10.1016/j.adaj.2016.12.008


Martin-Cabezas R, Davideau JL, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2016;43:520-530. http://dx.doi.org/10.1111/jcpe.12545.

Clinical relevance. The high prevalence and adverse consequences of chronic periodontitis make it a condition that dentists need to address every day. Although scaling and root planing (SRP) is the established treatment, clinicians are always looking for ways to improve their results.

Study summary. The authors conducted a systematic review (SR) to assess the effects of probiotics as an adjuvant treatment to SRP in patients with chronic periodontitis and no systemic diseases. The authors searched for randomized clinical trials (RCTs) comparing SRP and probiotics versus SRP alone in 3 electronic databases and periodontal journals up through July 2015. They included 4 trials that were conducted between 2010 and 2015, followed patients from 42 days up to 1 year, included 30 to 40 patients, and had low risk of bias. The authors performed a meta-analysis using the data closest to 3 months of follow-up. Participants who underwent SRP and received probiotics had a larger pocket depth reduction,* a larger clinical attachment level gain, and a larger percentage of bleeding on probing sites reduction than patients who received SRP alone. Gingival and plaque indexes were also better when probiotics were used with SRP. Two RCTs measured the need for surgery or persistent pockets and reported statistically significant differences that favored probiotics.

Strengths and limitations. This SR studied probiotics, an intervention that has shown to be promising in many medical areas. The authors performed a high-quality systematic review that addressed an explicit and focused question and appropriately chose studies and processed the data. The included RCTs had low risk of bias, consistent results, and precise pooled estimates, which increased our confidence in the results. We cannot ignore, however, the possibility of a "small study effect,"§ and we can only hope that the investigators of future RCTs confirm these results. The main limitation of this study was that although pocket depth and clinical attachment level are important to dentists, they are not meaningful outcomes to patients. In addition, the clinical significance of some of the statistical differences still needs to be determined. Finally, the outcomes were reported only up to 3 months, which may diminish the applicability of these results to clinical practice.

* Mean difference, 0.46 millimeters; 95% confidence interval (CI), –0.02 to 0.95; n = 3 studies, 100 patients.

† Mean difference, 0.42 mm; 95% CI, 0.16 to 0.68; n = 3 studies, 100 patients.

‡ Mean difference, 14.66%; 95% CI, 4.03 to 24.49; n = 3 studies, 100 patients.

§ Studies with a small sample size tend to show results more favorable to the intervention than larger studies.

¶ The magnitude of the effects (less than 1 mm difference) was smaller than the potential measurement error.

Disclosure. Dr. Brignardello-Petersen did not report any disclosures.