title: Probiotic supplements and debridement of peri-implant mucositis: a randomized controlled trial.
abstract: OBJECTIVE
  The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis.
  
  
  METHODS
  Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays.
  
  
  RESULTS
  After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups.
  
  
  CONCLUSIONS
  Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo.
authors.affiliation: a 1 Department of Periodontology, Faculty of Odontology, Malmö University , Malmö, Sweden.
authors.forename: Hadar
authors.initials: H
authors.lastname: Hallström
authors.affiliation: b 2 Maxillofacial unit, Halland Hospital , Halmstad, Sweden.
authors.forename: Susann
authors.initials: S
authors.lastname: Lindgren
authors.affiliation: c 3 Department of Oral Sciences, Kristianstad University , Kristianstad, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Widén
authors.affiliation: c 3 Department of Oral Sciences, Kristianstad University , Kristianstad, Sweden.|d 4 Blekinge Institute of Technology , Karlskrona, Sweden.|e 5 School of Dental Sciences, Trinity College , Dublin, Ireland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Renvert
authors.affiliation: b 2 Maxillofacial unit, Halland Hospital , Halmstad, Sweden.|f 6 Department of Odontology, Section for Cariology, Endodontics, Pediatric Dentistry and Clinical Genetics, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen, Denmark.
authors.forename: Svante
authors.initials: S
authors.lastname: Twetman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification; D016207:Cytokines / Q000032:analysis; D015921:Dental Implants; D003774:Dental Plaque Index; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D052200:Limosilactobacillus reuteri; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000382:microbiology / Q000628:therapy*; D009910:Oral Hygiene / Q000193:education; D057747:Periodontal Debridement / Q000379:methods*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000628:therapy; D010919:Placebos; D019936:Probiotics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D016207:Cytokines; D015921:Dental Implants; D018836:Inflammation Mediators; D010919:Placebos
keywords: Cytokines; gingival crevicular fluid; lactobacilli; lozenges; subgingival bacteria