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. 2024 Oct 15;24(1):1224.
doi: 10.1186/s12903-024-05027-6.

Probiotics in the non-surgical treatment of periodontitis: a systematic review and network meta-analysis

Carlota Duarte de Mendonça  1   2 , António Duarte Sola Pereira da Mata  1   2   3 , Luís Filipe Ribeiro Azevedo  4   5 , Joana Faria Marques  1   2   3 , João Miguel Lourenço Silveira  1   2   3 , Duarte Nuno da Silva Marques  6   7   8
Affiliations

Probiotics in the non-surgical treatment of periodontitis: a systematic review and network meta-analysis

Carlota Duarte de Mendonça et al. BMC Oral Health. .

Abstract

This systematic review and network meta-analysis aimed to assess the impact of combining professional mechanical plaque removal (PMPR) with probiotics compared to PMPR + placebo on probing pocket depth (PPD) and clinical attachment level (CAL). Randomized controlled trials published until November 2023 were searched across electronic databases, peer-reviewed journals, and grey literature. Two authors independently selected, extracted data, and assessed bias risk. Primary outcomes were mean changes in PPD and CAL. Secondary outcomes included mean changes in bleeding on probing (BOP), plaque index, and colony-forming units. Network meta-analysis with the frequentist weighted least squares approach evaluated the data quantitatively, and CINeMA framework evaluated the quality of evidence. In 33 articles involving 1290 patients, results were stratified by follow-up period (short and long-time studies) and sensitivity analyses conducted based on probiotic therapy duration (1 month reference). Network meta-analysis revealed significant mean differences in PPD for nine probiotic interventions, CAL for eighteen interventions, and BOP for eight interventions, with Lactobacillus demonstrating the most substantial effects. Combining PMPR with probiotics as adjuvants to subgingival instrumentation may be more effective in improving PPD and CAL. Lactobacillus emerged as the most comprehensive and effective among the studied probiotic.

Keywords: Chronic periodontitis; Network meta-analysis; Probiotics; Synbiotics; Systematic review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Network plot for primary outcomes [PPD (1 A), CAL (1B)] and secondary outcome [BOP (1 C)]. The nodes have the same size. Treatments with direct comparisons are linked with a line. These star networks emphasize two major comparators—SRP and SRP + placebo (Splac)—relying heavily on indirect evidence. Node color indicates risk of bias (RoB) of the intervention, while edge color signifies average RoB. Edge width corresponds to the number of studies comparing treatments. The PPD network includes 300 potential comparisons with 9% direct evidence, and the CAL network has 325 possible comparisons with 8.92% direct evidence. The BOP network comprises 120 potential comparisons, with 13% direct evidence
Fig. 2
Fig. 2
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study
Fig. 3
Fig. 3
Changes in PPD (3A; 3B). Effect sizes are presented as mean differences with a 9% confidence interval. MD = mean difference; CI = confidence interval
Fig. 4
Fig. 4
Changes in CAL (4A; 4B). Effect sizes are presented as mean differences with a 95% confidence interval. MD = mean difference; CI = confidence interval
Fig. 5
Fig. 5
Changes in BOP (5A; 5B). Effect sizes are presented as mean differences with a 95% confidence interval. MD = mean difference; CI = confidence interval
See this image and copyright information in PMC

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