Systematic review and meta‐analysis of double‐blind, placebo‐controlled, randomized clinical trials using probiotics in chronic periodontitis

Ikram, Salma; Hassan, Nuzhat; Raffat, Muhammad Arsalan; Mirza, Sana; Akram, Zohaib

doi:10.1111/jicd.12338

Cited by 66 publications

(57 citation statements)

References 34 publications

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“…The potential application of probiotics has increasingly been advocated in periodontal care, but there is a dearth of evidence from double‐blind, paralleled‐arm, placebo‐controlled and randomized clinical trials that this study aimed to address (Ikram, Hassan, Raffat, Mirza, & Akram, ). The response rate in terms of attending all periodontal care sessions and all follow‐up assessments was high (at almost 90%, 52/59).…”

Section: Discussionmentioning

confidence: 99%

A double‐blind, paralleled‐arm, placebo‐controlled and randomized clinical trial of the effectiveness of probiotics as an adjunct in periodontal care

Pelekos

Acharya

et al. 2019

J Clinic Periodontology

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Aim This study aimed to evaluate the clinical effectiveness of the probiotic Lactobacillus reuteri as an adjunct to non‐surgical periodontal therapy (NSPT). Materials and Methods A double‐blind, paralleled‐arm, placebo‐controlled and randomized clinical trial was conducted. Probiotics L. reuteri 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. Results The trial 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 < .001) and PPD (both, p < .001); and in secondary outcomes: percentage of sites with ‘bleeding on probing’ (both, p < .001) and visible plaque (both, p < .001). There were no statistically significant inter‐group differences in any outcomes at any time points (all, p > .05) nor in the changes in outcomes (∆) with time (all, p > .05). There was a trend of a greater magnitude of statistical change occurring among the test group compared to the control group. Conclusion 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).

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Section: Discussionmentioning

confidence: 99%

A double‐blind, paralleled‐arm, placebo‐controlled and randomized clinical trial of the effectiveness of probiotics as an adjunct in periodontal care

Pelekos

Acharya

et al. 2019

J Clinic Periodontology

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“… This is a gram‐negative anaerobic bacterium highly associated with periodontal disease and is considered a keystone pathogen in chronic periodontitis . In addition, systematic reviews and meta‐analysis support the use of L reuteri associated with conventional periodontal therapy, especially in deep pockets …”

Section: Introductionmentioning

confidence: 99%

Heat‐killed Lactobacillus reuteri and cell‐free culture supernatant have similar effects to viable probiotics during interaction with Porphyromonas gingivalis

Geraldo

Batalha

Milhan

et al. 2019

J of Periodontal Research

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Background and objective In the last decade, numerous studies have been published to clarify the role of probiotics, especially Lactobacillus reuteri, as an adjunct to conventional periodontal treatment. Although the health benefits of probiotics are numerous, they are live bacteria, and the administration of live organisms is not risk‐free. We evaluated the antimicrobial effect of L reuteri and its cell‐free culture supernatant on Porphyromonas gingivalis, a keystone periodontal pathogen, in vitro. We also evaluated the influence of this probiotic in its live, heat‐killed (HKL, paraprobiotic) form and its supernatant on the Galleria mellonella invertebrate model after infection by P gingivalis. Methods The interaction assay was conducted with P gingivalis and L reuteri preparations (live cells and supernatant preparation). For this, P gingivalis and L reuteri preparations were added to tubes containing Brain Heart Infusion broth and incubated for 3 days. The suspensions were then seeded onto appropriate culture media for the calculation of colony‐forming units per mL (CFU/mL). An in vivo assay with the G mellonella model was also performed. Live L reuteri, HKL, or supernatant was inoculated 2 hours prior to infection with P gingivalis. Survival was evaluated over 7 days, and the number of hemocytes in the hemolymph was estimated 3 hours after P gingivalis infection. Data were then subjected to statistical testing (α = 5%). Results Both live L reuteri and its supernatant had antimicrobial activity against P gingivalis (CFU reduction up to 86%, P < .05). Moreover, treatment with live and HKL had similar effects on G mellonella survival (increased survival up to 46%, P < .05). However, only live L reuteri was able to significantly increase the hemocyte density in this invertebrate model. Conclusion Lactobacillus reuteri antimicrobial activity against P gingivalis and its effects on G mellonella survival after infection with a periodontopathogen do not depend on cell viability. This allows the development of products without live bacterium while maintaining similar effects.

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“…The studies that evaluated the effects of probiotics on the treatment of periodontal disease demonstrated that they can reduce periodontopathogens, improve periodontal clinical parameters, decrease the levels of proinflammatory cytokines, and potentiate the effects of SRP Shah, Gujjari, & Chandrasekhar, 2013;Tekce et al, 2015;Teughels et al, 2013;Vivekananda, Vandana, & Bhat, 2010). In fact, two meta-analyses seem to support the adjunctive use of probiotics in the treatment of chronic periodontitis (Ikram, Hassan, Raffat, Mirza, & Akram, 2018;Martin-Cabezas, Davideau, Tenenbaum, & Huck, 2016). Nevertheless, further high-quality randomized clinical trials with microbiological outcomes are warranted to obtain strong conclusions in this regard (Ikram et al, 2018).…”

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confidence: 99%

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial

Invernici

Salvador

Silva

et al. 2018

J Clinic Periodontology

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AimThis randomized placebo‐controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019‐containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis.Materials and MethodsForty‐one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed.ResultsThe Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days.ConclusionThe use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).

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Systematic review and meta‐analysis of double‐blind, placebo‐controlled, randomized clinical trials using probiotics in chronic periodontitis

Abstract: Adjunctive probiotics could result in additional benefits in CAL gain in CP. Nevertheless, further high-quality randomized clinical trials with microbiological outcomes are warranted to obtain strong conclusions in this regard.

Cited by 66 publications

References 34 publications

A double‐blind, paralleled‐arm, placebo‐controlled and randomized clinical trial of the effectiveness of probiotics as an adjunct in periodontal care

A double‐blind, paralleled‐arm, placebo‐controlled and randomized clinical trial of the effectiveness of probiotics as an adjunct in periodontal care

Heat‐killed Lactobacillus reuteri and cell‐free culture supernatant have similar effects to viable probiotics during interaction with Porphyromonas gingivalis

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial

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