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SANZ et al .
PPD reduction of 0.38 mm (95% CI [−0.14; 0.90]) at 6 months. The confidence interval and I 2 statistic (93.3%) suggested considerable heterogeneity for the effect of the treatment with the different formulations. Clinical relevance The mean estimated difference in PPD reduction between pro - biotics and placebo was not statistically significant and of lim - ited clinical relevance (difference < 0.5 mm). Moreover, two groups published four out of the five RCTs included each of them using a different probiotic formulation. Preparations containing Lactobacillus reuteri were the only ones to demonstrate improved PPD reductions. Given that probiotics embrace a broad range of micro-organisms and types of preparations, combining such data within the same me - ta-analysis poses an interpretational challenge. Balance of benefits and harms All formulations appeared to be safe and patients did not report ad - verse effects. Economic considerations There is an additional cost associated with the use of probiotics that is borne by the patient. Applicability All studies were conducted in two countries, and no conclusions can be drawn on the effectiveness of probiotics as adjuncts to subgingi - val instrumentation. R2.8 | Does the adjunctive use of systemic sub-antimicrobial dose doxycycline (SDD) to subgingival instrumentation improve clinical outcomes? Evidence-based recommendation (2.8) We suggest not to use systemic sub-antimicrobial dose doxycycline (SDD) as an adjunct to subgingival instrumentation. Supporting literature Donos et al. (2019) Quality of evidence Eight placebo-controlled RCTs (14 publications, n = 610). Meta-analysis on PPD reduction was performed in five RCTs ( n = 484) Grade of recommendation Grade B—↓ Strength of consensus Consensus (1.3% of the group abstained due to potential CoI)
(e.g. medical history, smoking history). In addition, future studies will need to clarify which type of statin is more effective.
R2.7 | Does the adjunctive use of probiotics improve the clinical outcome of subgingival instrumentation? Evidence-based recommendation (2.7) We suggest not to use probiotics as an adjunct to subgingival instrumentation Supporting literature Donos et al. (2019) Quality of evidence Five placebo controlled RCTs ( n = 176) testing preparations containing L. ramnosus SP1, L. reuteri or the combination of S. oralis KJ3, S. uberis KJ2 and S. rattus JH145. Grade of recommendation Grade B—↓ Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Intervention Probiotics are defined as “live microorganisms which, when admin - istered in adequate amounts, confer a health benefit on the host” (FAO/WHO). It has been suggested that probiotics may alter the ecology of micro-environmental niches such as periodontal pock - ets, and as such, they may disrupt an established dysbiosis. This may re-establish a symbiotic flora and a beneficial interaction with the host via several mechanisms including modulation of the immune- inflammatory response, regulation of antibacterial substances and exclusion of potential pathogens via nutritional and spatial competi - tion (Gatej, Gully, Gibson, & Bartold, 2017). This guideline does not include evidence on the use of probiotics in supportive periodontal therapy. Available evidence Five placebo-controlled RCTs ( n = 176) assessed the adjunctive effect of probiotics to subgingival instrumentation. Two studies from the same group used a preparation containing L. ramnosus SP1 (2 × 10 7 colony forming units). Two other RCTs from another research group used a preparation containing L. reuteri . One study evaluated a combination of S. oralis KJ3, S. uberis KJ2 and S. rattus JH145. Meta-analysis was performed on PPD reduction (primary outcome) at 6 months. Risk of bias All studies had an overall low risk of bias. Two out of the five studies declared industrial sponsorship, and three received the probiotics from industry. Consistency Meta-analysis of five RCTs demonstrated that, compared with pla - cebo, treatment with probiotics resulted in a mean difference in
Background
Intervention Sub-antimicrobial dose doxycycline (up to 40 mg a day) is a systemic drug employed specifically for its anti-inflammatory as opposed to its antimicrobial properties. The formulation offers anti-collagenolytic
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