What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?

Introduction

Oral probiotics are considered one of the adjunctive means for the treatment of periodontal diseases, but limited evidence exists regarding their efficacy in peri-implant diseases. The study conducted by the Catalan University in Barcelona aimed to clinically and microbiologically evaluate the effect of the oral probiotic Limosilactobacillus reuteri Prodentis as an adjunct to non-surgical mechanical therapy in patients with implants who had mucositis or peri-implantitis and a history of periodontal disease.

Methodology and Course of the Study

This was a randomized controlled triple-blind prospective clinical study with parallel arms. Patients included in the study suffered from partial dentition absence and had areas around dental implants affected by mucositis or peri-implantitis. Implants with radiographic bone loss ≥ 5 mm and/or ≥ 50% of the implant length were excluded; only 1 implant per patient was included.

In implants with mucositis, supragingival prophylaxis was performed, and implants affected by peri-implantitis were treated with subgingival non-surgical mechanical therapy using an ultrasonic generator with carbon tips and titanium curettes. Participants were then randomly assigned to groups taking either 1 probiotic lozenge or 1 placebo lozenge daily for 30 days. Clinical measurements were performed across the entire mouth (total plaque index and total bleeding on probing) and at the implant site (probing pocket depth, plaque index, and bleeding on probing) at the beginning and after 30 and 90 days. Microbiological examinations (to identify Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus, and Eikenella corrodens) were conducted at the same study time points as clinical measurements.

Results

A total of 44 patients – 22 with mucositis and 22 with peri-implantitis – were randomized to receive either probiotics or placebo. The L. reuteri probiotic in combination with mechanical therapy provided additional improvement over mechanical therapy alone, both in general clinical parameters of patients with mucositis (bleeding on probing) and in the evaluation of implants with mucositis (probing pocket depth) or peri-implantitis (bleeding on probing and probing pocket depth). However, L. reuteri had only a limited effect on peri-implant microbiota, as the only parameter significantly decreased was the bacterial load of P. gingivalis in implants with mucositis (p = 0.031).

Conclusion

Daily administration of a lozenge containing L. reuteri for 30 days, combined with whole mouth mechanical debridement improved clinical parameters of patients with implants with mucositis or peri-implantitis for at least 90 days, although the effect on microbiota was limited. It can be said that probiotics represent a suitable adjunct to the treatment in the prevention and management of peri-implant diseases and provide an alternative therapeutic approach to be considered.

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Source: Galofré M., Palao D., Vicario M. et al. Clinical and microbiological evaluation of the effect of Lactobacillus reuteri in the treatment of mucositis and peri-implantitis: a triple-blind randomized clinical trial. J Periodontal Res 2018; 53 (3): 378–390, doi: 10.1111/jre.12523.