The Efficacy Of Probiotics In Adjuvant Therapy Of Periodontitis:a Systematic Review And Meta-analysis

Objectives:Chronic periodontitis?CP?is an inflammatory disease of periodontal tissues.Bacteria are the initial factor of chronic periodontitis.Chronic periodontitis can lead to loss of periodontal attachment,destruction of alveolar bones,which in turn can lead to tooth loss.A typical non-surgical treatment of chronic periodontitis is the removal of microbes,toxins and calculus on the tooth surface by scaling and root planing?SRP?to promote the recovery of periodontal tissues.However,in some areas of deep periodontal pockets and root bifurcations,the effect of SRP alone is not ideal.Therefore,some non-surgical adjunctive treatments for periodontitis such as antibiotic,laser therapy,and photodynamic therapy are proposed.In order to avoid the problems of antibiotic resistance,probiotics are increasingly receiving attention as a method of adjunctive treatment of chronic periodontitis.At the same time,it is more convenient for patients to use probiotics at home.As a treatment for gastrointestinal diseases,probiotics have been widely used worldwide.Probiotics are beneficial microorganisms that can prevent the adhesion of pathogenic bacteria,inhibit the growth of bacteria,regulate the mucosal immune system or cell proliferation,and promote the formation of new oral biofilms.Recently,many experiments have evaluated the effectiveness of probiotics in human microbial imbalances,such as the mouth,skin,urogenital tract,and respiratory tract.The aim of this study was to analyze the efficacy of probiotics in the treatment of chronic periodontitis and provide references for clinical treatment.Methods:Studies were searched in EMbase,PubMed,The Cochrane Library,Wanfang Database,and CNKI.The search period is from database building to 1^st,January 2019.Two researchers independently screened the literature,extracted the data,and evaluated the quality of the included studies.Meta-analysis was performed in R software.Results:Seven randomized controlled trials?RCTs?and 246 patients were included.Results of the Meta-analysis showed that compared with SRP treatment alone within 3 months,the reduction in probiotics with SRP were significantly higher in PD,PD in medium depth periodontal pockets,PD in deep periodontal pockets,CAL,and BOP.And the mean difference?MD?and 95%confidence interval were[MD=0.22,95%CI=?0.09,0.34?,P<0.01],[MD=0.54,95%CI=?0.25,0.85?,P<0.01],[MD=0.21,95%CI=?0.03,0.39?,P=0.02]and[MD=5.39,95%CI=?4.44,6.34?,P<0.001]separately.Conclusions:Probiotics adjunvant SRP is more effective than SRP alone in the treatment of chronic periodontitis in PD,CAL and BOP reduction within 3 months.Probiotics in adjuvant therapy of periodontitis is effective at short-term,especially in deep pockets.It is a effective adjunctive treatment of CP.