RESUMO
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.
RESUMO
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)