Clinical Effects of Probiotic or Azithromycin as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis Stage III: A Pilot Randomized Controlled Clinical Trial

Abstract

Background The aim of this triple- blind placebo- controlled parallel- arm randomized clinical trial was to evaluate the clinical effects of Lactobacillus rhamnosus SP1 or azithromycin as an adjunct to scaling and root planing (SRP) in patients with periodontitis stage III. Methods Forty-seven systemically healthy participants with periodontitis stage III were recruited. Following SRP, the participants were randomly assigned to one of three treatment modalities; 1) placebo (n = 15), 2) probiotics (n = 16) and 3) antibiotics-azithromycin (n = 16). The participants were monitored at baseline, 3, 6, 9 and 12 months after therapy. Probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment loss (CAL) and plaque accumulation (PI) were evaluated. Results All 47 participants completed the study. At 12 months, all groups showed significant improvements of PPD and PI (p < 0.012) irrespective of the treatment modality and without significant differences between the groups. Probiotics and azithromycin showed no added benefit in terms of CAL. While the placebo (p = 0.002) and the antibiotic-azithromycin (p = 0.002) group showed a significant reduction of BOP, only the placebo group revealed a significant reduction of CAL at 12 months follow-up (p = 0.003). The number of sites and teeth with PPD ≥ 5, ≥6 and ≥ 7 mm were significantly reduced in all groups at 12 months follow-up (p < 0.025) irrespective of the treatment regime and without significant differences between the groups. Conclusion The use of probiotics or azithromycin as an adjunct to SRP failed to provide additional benefits in the treatment of periodontitis stage III. The benefits of these two treatment regimes as an adjunct to SRP remain unclear.