Publication: Tratamiento no quirúrgico de la periodontitis en pacientes con diabetes: uso coadyuvante de probióticos. Estudio piloto.
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2022
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Abstract
Objetivo
Investigaciones previas han demostrado que el uso coadyuvante de pastillas con Lactobacillus reuteri pueden aportar un beneficio adicional en la terapia periodontal. Sin embargo, no existen estudios en la literatura que evalúen los efectos del uso de probióticos en pacientes diabéticos con periodontitis. Por tal motivo, el objetivo de este estudio es evaluar el desempeño clínico de una formulación probiótica, que contiene L. reuteri, durante 3 meses como complemento de la instrumentación subgingival (raspado y alisado radicular, RAR) en comparación con RAR combinado con un placebo en pacientes diabéticos con periodontitis.
Material y métodos
Se incluyeron, hasta el momento, 11 pacientes con periodontitis y diabetes mellitus (DM),que fueron reclutados y evaluados, tanto en el control metabólico como clínicamente, al inicio y a los 3 meses después de la terapia. Los pacientes recibieron instrucciones estandarizadas de higiene oral, incluyendo el uso de un cepillo de dientes, y cepillos interdentales. Todos los pacientes recibieron desinfección de boca completa en dos etapas y se asignaron aleatoriamente a un grupo de prueba (RAR + probiótico, que contiene L. reuteri 2x108 unidades formadoras de colonia/tableta de las cepas ATCC 55730 y ATCC PTA) o control (RAR + placebo). Las pastillas se usaron dos veces al día durante 12 semanas. Se usó ANOVA y la prueba de rangos múltiples para comparar la visita inicial con las visitas a los 3 meses (comparaciones intragrupo) y ANCOVA se utilizó para comparar ambos grupos (comparación entre grupos).
Resultados
La población por intención de tratar consistió en 11 sujetos asignados aleatoriamente al grupo A (n = 5) o al grupo B (n = 6). Después del tratamiento, el análisis intragrupo mostró una mejora estadísticamente significativa para ambos grupos en el parámetro clínico: índice de placa. En cuanto al sangrado al sondaje solo se encontró una mejora estadísticamente significativa en el grupo B, a los tres meses. También se evidencio una reducción en bolsas profundas estadísticamente significativa en el grupo A, transcurridos los tres meses (p < 0,05). Sin embargo, la comparación entre grupos de los parámetros periodontales clínicos no mostró diferencias stadísticamente significativas.
Conclusiones
El uso coadyuvante de probióticos que contiene L. reuteri, como complemento de la instrumentación subgingival, no demostró beneficios clínicos adicionales en comparación con la instrumentación subgingival sola en el tratamiento de la periodontitis.
Aim Prior research has demonstrated that the adjunctive use of tablets with Lactobacillus reuteri can provide an additional benefit in periodontal therapy. However, there are no studies in the literature that evaluate the effects of the use of probiotics in diabetic patients with periodontitis. For this reason, the objective of this study is to evaluate the clinical performance of a probiotic formulation, containing L. reuteri, for 3 months as an adjunct to subgingival instrumentation (scaling and root planning, SRP) compared to SRP combined with a placebo in diabetic patients with periodontitis. Material and methods Eleven patients with periodontitis and diabetes mellitus were included, were recruited and monitored for clinical and metabolic control at baseline and at 3 months after therapy. Patients received standardized oral hygiene instructions, including the use of a toothbrush and interdental brushes. All patients received two-stage full-mouth disinfection and were randomly assigned to a test group (SRP + probiotic) containing L. reuteri 2x108 colony-forming units/tablet of strains ATCC 55730 and ATCC PTA or control (SRP + placebo). The pills were used twice a day for 12 weeks. ANOVA and multiple range test were used to compare baseline and 3-month visits (within group comparisons) and ANCOVA was used to compare both groups (between group comparison). Results The intention to treat population consisted of 11 subjects randomly assigned to group A (n = 5) or group B (n = 6). After treatment, intragroup analysis showed a statistically significant improvement for both groups in the clinical parameter: plaque index. Regarding bleeding on probing, a statistically significant improvement was only found in group B, at three months. There was also a statistically significant reduction in deep pockets in group A, after three months (p < 0.05). However, the comparison between groups of clinical periodontal parameters did not show statistically significant differences. Conclusions The adjunctive use of probiotics containing L. reuteri, as an adjunct to subgingival instrumentation, did not show additional clinical benefits, when compared to subgingival instrumentation alone in the treatment of periodontitis.
Aim Prior research has demonstrated that the adjunctive use of tablets with Lactobacillus reuteri can provide an additional benefit in periodontal therapy. However, there are no studies in the literature that evaluate the effects of the use of probiotics in diabetic patients with periodontitis. For this reason, the objective of this study is to evaluate the clinical performance of a probiotic formulation, containing L. reuteri, for 3 months as an adjunct to subgingival instrumentation (scaling and root planning, SRP) compared to SRP combined with a placebo in diabetic patients with periodontitis. Material and methods Eleven patients with periodontitis and diabetes mellitus were included, were recruited and monitored for clinical and metabolic control at baseline and at 3 months after therapy. Patients received standardized oral hygiene instructions, including the use of a toothbrush and interdental brushes. All patients received two-stage full-mouth disinfection and were randomly assigned to a test group (SRP + probiotic) containing L. reuteri 2x108 colony-forming units/tablet of strains ATCC 55730 and ATCC PTA or control (SRP + placebo). The pills were used twice a day for 12 weeks. ANOVA and multiple range test were used to compare baseline and 3-month visits (within group comparisons) and ANCOVA was used to compare both groups (between group comparison). Results The intention to treat population consisted of 11 subjects randomly assigned to group A (n = 5) or group B (n = 6). After treatment, intragroup analysis showed a statistically significant improvement for both groups in the clinical parameter: plaque index. Regarding bleeding on probing, a statistically significant improvement was only found in group B, at three months. There was also a statistically significant reduction in deep pockets in group A, after three months (p < 0.05). However, the comparison between groups of clinical periodontal parameters did not show statistically significant differences. Conclusions The adjunctive use of probiotics containing L. reuteri, as an adjunct to subgingival instrumentation, did not show additional clinical benefits, when compared to subgingival instrumentation alone in the treatment of periodontitis.
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