The Use of Probiotics as Adjuvant Therapy of Periodontal Treatment: A Systematic Review and Meta-Analysis of Clinical Trials

Abstract

For many years, the use of probiotics in periodontitis treatment was reflected in their abilities to control the immune response of the host to the presence of pathogenic microorganisms and to upset periodontopathogens. Accordingly, the aim of the present study was to assess the use of probiotics as adjuvant therapy on clinical periodontal parameters throughout a systematic review and meta-analysis. The literature was screened, up to 4 June 2021, by two independent reviewers (L.H. and R.B.) in four electronic databases: PubMed (MedLine), ISI Web of Science, Scielo, and Scopus. Only clinical trials that report the effect of the use of probiotics as adjuvants in the treatment of periodontal disease were included. Comparisons were carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A total of 21 studies were considered for the meta-analysis. For the index plaque, the use of probiotics did not improve this clinical parameter (p = 0.16). On the other hand, for the periodontal pocket depth, the clinical attachment loss, the bleeding on probing, and the use of probiotics as adjuvant therapy resulted in an improvement of these parameters, since the control group achieved statistically higher values of this parameter (p < 0.001; p < 0.001; and p = 0.005, respectively). This study suggests that the use of probiotics led to an improvement in periodontal pocket depth, clinical attachment loss, and bleeding on probing parameters. On the other hand, this protocol seems to not be beneficial for the index plaque parameter.

Rational Design of Bioactive Hydrogels toward Periodontal Delivery: From Pathophysiology to Therapeutic Applications

“…[183,184] Probiotics and prebiotics could maintain and restore the harmonious equilibrium of the periodontal microbiome, which have been employed for adjunctive treatment of periodontitis. [185][186][187][188] Therefore, future studies could incorporate new bioactive agents into the design of hydrogel delivery systems to restore periodontal microbial equilibrium for periodontitis treatment.…”

Probiotic Bifidobacteria in Managing Periodontal Disease: A Systematic Review

“…Different probiotic bacteria have been investigated as adjunct treatment modalities in the management of periodontal diseases. 7 It has been hypothesised that sufficient numbers of healthy probiotic bacteria could counter the injurious toxic effects of periodontopathogens and restore the diseased site to health. 8 Probiotics are known to restore health not only by suppressing periodontopathogens but also by modulating immunologic responses, epithelial permeability, bacterial translocation, and the provision of regulatory metabolites.…”

“… 9 In this context, several probiotics such as Lactobacillus and Bifodobacterium genera have been investigated for their utility as useful adjuncts in the management of periodontal diseases. 7 , 10 …”

Immune infiltration and diagnostic value of immune‐related genes in periodontitis using bioinformatics analysis

“…13 Probiotics are used for periodontitis treatment to upset periodontopathogens and to control the host's immune response to the presence of pathogenic microorganisms. [14][15][16] All these findings suggest that immunity has the potential to provide new ideas for the pathogenesis, diagnosis, and treatment of periodontitis. Clarifying the immune infiltration of the disease is necessary to understand the association between immunity and periodontitis.…”

“…Additionally, Zou et al reviewed the role of regulatory T and B cells and their therapeutic application in periodontitis 13 . Probiotics are used for periodontitis treatment to upset periodontopathogens and to control the host's immune response to the presence of pathogenic microorganisms 14–16 . All these findings suggest that immunity has the potential to provide new ideas for the pathogenesis, diagnosis, and treatment of periodontitis.…”