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

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.