Effect of Probiotic Therapy (Lactobacillus reuteri) in the treatment of chronic periodontitis associated with Diabetes Mellitus. Clinical, controlled and randomized study

Aim: Subgingival instrumentation with probiotics may be a proposal for the treatment of periodontitis (P), especially for patients with type 2 Diabetes Mellitus (T2DM). The Lactobacillus reuteri probiotic as an adjunctive therapy in the treatment of P associated with T2DM were evaluated. Materials and Methods: Forty diabetic participants diagnosed with P (Stage III and IV, Grade B), were randomized into SRP+Placebo (n=20): subgingival instrumentation plus placebo lozenges and SRP+Probi (n=20): subgingival instrumentation plus probiotics. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque index (PI), bleeding on probing (BoP) and PISA index were performed at baseline, 30, 90 and 180 days. Cytokines concentration in the gingival crevicular fluid, subgingival biofilm sample and LDL and HDL subfractions were evaluated. Results: Subgingival instrumentation improved the clinical periodontal parameters in both groups (p<0.05), the PISA index and interfered in the cytokine levels. There was a reduction in all microbial complexes. SRP+Probi showed a better result in the LDL and HDL subfractions. Conclusion: Subgingival instrumentation improved the clinical periodontal parameters in patients with T2DM. The use of L. reuteri probiotics had no additional effects compared with the placebo, however, there was a positive effect on the lipoprotein subfraction.