Effect of Adjunctive Use of Probiotics in the Treatment of Peri-Implant Mucositis: A Systematic Review and Meta-Analysis

This review was performed to analyze evidence from the scientific literature of the adjunctive effect of probiotics in the treatment of peri-implant mucositis (PiM). Only randomized clinical trials evaluating the effect of probiotics as an adjunct to mechanical debridement in PiM were included. A search was performed in PubMed/MEDLINE, LILACS, ScienceDirect, and Web of Science to identify articles published in English up to January 2023. The quality of the studies was evaluated using the JADAD scale, and the risk of bias was assessed with the Cochrane Collaboration assessment tool. Of the 159 potentially relevant studies, only 9 studies were included. The most commonly used strain was Lactobacillus reuteri, and the meta-analysis was conducted on studies with a follow-up period of 3 to 6 months, observing an overall effect on the reduction of bleeding on probing (BOP) at 3 and 6 months (WMD = -1.13, 95% CI = -1.95 to -0.30, p = 0.007; and WMD = -1.32, 95% CI = -2.15 to -0.48, p = 0.002), plaque index (PI) at 3 months (WMD = -1.22, 95% CI = -2.25 to -0.19, p = 0.02), and probing pocket depth (PPD) at 3 and 6 months, which was statistically significant in favor of the probiotic group (WMD = -1.34, 95% CI = -2.42 to -0.25, p = 0.02 and WMD = -1.36, 95% CI = -2.61 to -0.11, p = 0.03). On the other hand, there were no significant changes in the subgingival microflora around the implants with the use of probiotics. Probiotic therapy, as an adjunct to mechanical debridement, promotes a greater reduction in BOP, PPD, and PI, in relation to the control group without probiotics.