Effect of systemic antibiotic and probiotic therapies as adjuvant treatments of subgingival instrumentation for periodontitis: a randomized controlled clinical study.

OBJECTIVE: This study assessed the efficacy of two adjunct therapies (antibiotic and probiotic) for periodontal treatment based on clinical and immunological parameters in patients with Stage II and III Grade B periodontitis. METHODOLOGY: 45 patients were randomly allocated into three groups: control group (CG); antibiotic group (GAtb), in which 500 mg amoxicillin + 400 mg metronidazole were used; and probiotic group (GProb), for which Lactobacillus reuteri was used. Patients received medications after undergoing periodontal debridement. Clinical and immunological parameters were assessed at baseline, 30 days, and 90 days. RESULTS: All therapies reduced bleeding on probing (BoP) in the evaluated periods, and the GAtb had a greater reduction at 90 days (p=0.03). The GProb group showed better results for plaque index (PI) and gingival recession (GR) compared to the GAtb at 90 days (p=0.0014; p=0.006). The area of inflammation (PISA Index) significantly decreased in all therapies in the evaluated periods. Therapies had no significant differences regarding moderate pockets. The GAtb had a greater reduction in probing depth (PD) for deep pockets (p=0.03) at 90 days and in the number of deep pocket sites at 30 days (p=0.04). The occurrence of adverse effects was commonly reported in the GAtb as a percentage per patient. The GAtb had a significant reduction in the concentration of interleukins IL-1ß and IL-8 and an increase in IL-10 and TNF-α. The CG had a reduction in IL-6 and IL-1 ß, whereas in the GProb there was no difference. CONCLUSION: After three months, none of the adjuvant therapies provided any additional benefit for subgingival instrumentation.

Effect of systemic antibiotic and probiotic therapies as adjuvant treatments of subgingival instrumentation for periodontitis: a randomized controlled clinical study

Abstract Objective: This study assessed the efficacy of two adjunct therapies (antibiotic and probiotic) for periodontal treatment based on clinical and immunological parameters in patients with Stage II and III Grade B periodontitis. Methodology: 45 patients were randomly allocated into three groups: control group (CG); antibiotic group (GAtb), in which 500 mg amoxicillin + 400 mg metronidazole were used; and probiotic group (GProb), for which Lactobacillus reuteri was used. Patients received medications after undergoing periodontal debridement. Clinical and immunological parameters were assessed at baseline, 30 days, and 90 days. Results: All therapies reduced bleeding on probing (BoP) in the evaluated periods, and the GAtb had a greater reduction at 90 days (p=0.03). The GProb group showed better results for plaque index (PI) and gingival recession (GR) compared to the GAtb at 90 days (p=0.0014; p=0.006). The area of inflammation (PISA Index) significantly decreased in all therapies in the evaluated periods. Therapies had no significant differences regarding moderate pockets. The GAtb had a greater reduction in probing depth (PD) for deep pockets (p=0.03) at 90 days and in the number of deep pocket sites at 30 days (p=0.04). The occurrence of adverse effects was commonly reported in the GAtb as a percentage per patient. The GAtb had a significant reduction in the concentration of interleukins IL-1β and IL-8 and an increase in IL-10 and TNF-α. The CG had a reduction in IL-6 and IL-1 β, whereas in the GProb there was no difference. Conclusion: After three months, none of the adjuvant therapies provided any additional benefit for subgingival instrumentation.

Efeito das terapias antibiótica e probiótica no tratamento adjuvantes da periodontite: estudo clínico controlado randomizado / Effect of antibiotic and probiotic therapies on adjuvant treatment of periodontitis: randomized controlled trial

O objetivo deste projeto foi avaliar a resposta dos parâmetros periodontais clínicos: Índice de Placa (IP), Sangramento à Sondagem (SS), Profundidade de sondagem (PS), Recessão gengival (RG) e Nível de Inserção Clínica (NIC) e PISA, diante da comparação de duas diferentes terapias adjuvantes (antibiótico e probiótico) para o tratamento da periodontite (Grau B Estágios II e III). Para tal, 45 pacientes foram incluídos no estudo divididos aleatoriamente em 3 grupos com n=15: grupo DEB (Debridamento); grupo DEB+ATB (Debridamento + Amoxicilina 500mg + Metronidazol 400mg) e grupo DEB+PROBI (Debridamento+Probiótico Lactobacillus reuteri). As análises dos parâmetros clínicos foram realizadas no Baseline, 30 dias e 90 dias. Para os dados não paramétricos foi realizado o teste de variância KruskalWallis através do software BioEstat 5.3 (Belém, PA, Brazil) e teste de Dunn post hoc para as comparações múltiplas. Para os dados com distribuição normal, foi utilizado o teste Qui-Quadrado e One Way ANOVA, todos com α = 5%. Em relação ao IP o grupo DEB+PROBI apresentou menores valores em relação aos demais grupos em 30 dias (0,43 ± 0,13, p=0,008) e em 90 dias (0,43 ± 0,11, p= 0,001). Para SS na comparação intergrupos o grupo DEB+ATB apresentou menores valores em 90 dias (0,28 ± 0,07, p= 0,03). Para PS e NIC de boca toda na comparação intergrupos não houve diferença estatística entre os valores. Para RG de boca toda o grupo DEB+PROBI apresentou diferença estatística (0,35± 0,15, p=0,006). Os valores de PISA não apresentaram diferenças estatisticamente significantes na comparação intergrupos. Em relação à estratificação das bolsas (moderadas e profundas), a PS para bolsas profundas apresentou na comparação intergrupos menores valores em 90 dias para o grupo DEB+ATB (4,31 ± 0,84, p=0,02) e em relação a quantidade de bolsas residuais, na comparação intergrupos o grupo DEB+ATB apresentou uma menor quantidade de sítios (0,93 ± 1,28, p=0,04) em 30 dias. O grupo DEB+ATB apresentou uma maior quantidade de efeitos adversos quando comparado ao grupo DEB+PROBI, o qual nenhum paciente relatou a ocorrência de efeitos adversos. Podemos concluir que ambas terapias adjuvantes, durante o período de avaliação de 90 dias, apresentaram resultados sem diferenças estatísticamente significantes na redução da profundidade de sondagem, porém, clinicamente, apesar de uma maior incidência de efeitos adversos, o antibiótico mostrou-se mais eficaz na redução de bolsas profundas(AU)

The objective of this project was to evaluate the response of clinical periodontal parameters: Plaque Index (IP), Bleeding on Probing (BoP), Probing Depth (PD), Gingival Recession (GR), Clinical Attachment Level (CAL) and PISA, comparing two different adjuvant therapies (antibiotic and probiotic) for the treatment of periodontitis (Grade B Stages II and III). For this, 45 patients were included in the study, randomly divided into 3 groups with n = 15: DEB group (Debridement); DEB + ATB group (Debridement + Amoxicillin 500mg + Metronidazole 400mg) and DEB + PROBI group (Debridement + Lactobacillus reuteri probiotic). The analyzes of clinical parameters were performed at baseline, 30 days and 90 days. For non-parametric data, the Kruskal-Wallis variation test was performed using the BioEstat 5.3 software (Belém, PA, Brazil) and Dunn post hoc test for multiple comparisons. For data with normal distribution, the Chi-Square and One Way ANOVA tests were used, all with α = 5%. Regarding PI, DEB + PROBI group presents lower values in relation to the other groups in 30 days (0.43 ± 0.13, p = 0.008) and in 90 days (0.43 ± 0.11, p = 0.001). For BoP in the intergroup comparison of the DEB + ATB group, the values are lower in 90 days (0.28 ± 0.07, p = 0.03). For PD and CAL of full mouth parameters the comparative comparison showed that there was no statistical difference between the values. For full mouth GR, DEB + PROBI group shows statistical difference (0.35 ± 0.15, p = 0.006). The PISA values did not show statistically significant differences in the comparison between groups. Regarding the pockets stratification (moderate and deep), a PD for deep pockets shows at the intergroup comparison lower values in 90 days for the DEB + ATB group (4.31 ± 0.84, p = 0.02) and in relation to the number of residual pockets, in the comparison between groups, the group DEB + ATB, presents a smaller number of sites (0.93 ± 1.28, p = 0.04) in 30 days. The DEB + ATB group had a higher number of adverse effects when compared to the DEB + PROBI group in which no patient related to the occurrence of adverse effects. we can conclude that both adjunct therapies during the 3-month evaluation period showed results without statistically significant differences, however clinically, despite having a higher incidence of adverse effects, the antibiotic proved to be more effective in reducing deep pockets(AU)

Probiotic therapy as a novel approach in the prevention and treatment of gingivitis. a review / Terapia probiótica como uma nova abordagem na prevenção e tratamento da gengivite. Uma revisão

Objective: Gingivitis is caused by a mixture of Gram-positive and Gram-negative species and is characterized by inflammatory exudate in the marginal region. Probiotics have been introduced in the prevention and treatment of periodontal diseases and represent an innovative approach to maintaining oral health using beneficial bacteria when administered in adequate amounts. The mechanism of action of probiotics in the oral cavity is not fully understood but is commonly explained by a combination of local and systemic immunomodulation. The results of the studies suggest that probiotics may be useful in the prevention and treatment of gingivitis, but their effectiveness is still very questionable. Thus, more in vivo research is needed through randomized controlled studies evaluating the main periodontal clinical parameters, levels of inflammatory mediators and microbiological analyzes, especially to elucidate some still unknown mechanisms of action and to ensure the use of probiotics as an effective therapy in the prevention and treatment of gingivitis. (AU)

Objetivo: A gengivite é causada por uma mistura de espécies Gram-positivas e Gram-negativas e é caracterizada pelo exsudado inflamatório na região marginal. Os probióticos tem sido introduzido na prevenção e tratamento das doenças periodontais e representam uma abordagem inovadora para manter a saúde bucal através da utilização de bactérias benéficas quando administradas em quantidades adequadas. O mecanismo de ação dos probióticos na cavidade bucal não é totalmente compreendido, mas é comumente explicado por uma combinação de imunomodulação local e sistêmica. Os resultados dos estudos sugerem que os probióticos podem ser úteis na prevenção e tratamento da gengivite, porém sua eficácia é muito questionável ainda. Desta forma, são necessárias mais pesquisas in vivo através de estudos randomizados controlados avaliando os principais parâmetros clínicos periodontais, níveis de mediadores inflamatórios e analises microbiológicas, especialmente para elucidar alguns mecanismos de ação ainda desconhecido e para assegurar a utilização dos probióticos como terapia eficaz na prevenção e tratamento da gengivite.(AU)