Clinical and Microbiological Effectiveness of Limosilactobacillus Reuteri in Supportive Periodontal Therapy: Randomized Clinical Trial

Clinical and Microbiological Effectiveness of Limosilactobacillus Reuteri in Supportive Periodontal Therapy: Randomized Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical and Microbiological Effectiveness of Limosilactobacillus Reuteri in Supportive Periodontal Therapy: Randomized Clinical Trial Magda Mensi, Eleonora Scotti, Silvia Marchetti, Annamaria Sordillo, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6642765/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Aug, 2025 Read the published version in Clinical Oral Investigations → Version 1 posted 10 You are reading this latest preprint version Abstract Objectives The purpose of the present randomized clinical trial was to evaluate the clinical and microbiological effects of Limosilactobacillus reuteri probiotic therapy as an adjunct to Guided Biofilm Therapy (GBT) during supportive periodontal therapy (SPT) of patients with a history of stage III or IV and grade B or C periodontitis and residual pockets. Materials and Methods Forty-four systemically healthy patients were selected. Complete periodontal assessment was performed including Pocket Probing Depth (PPD), Bleeding on Probing (BOP), Plaque index (PI), Clinical Attachment Loss (CAL) and Recession (REC). Two sites per patient with PPD ≥ 6 mm or PPD of 5 mm with bleeding on probing were selected in two different quadrants as test sites. A session of full-mouth debridement was provided at baseline (T0), and patients were randomized to receive a 3-weeks treatment with lozenges containing probiotic or placebo. Periodontal parameters and microbiological samples from the test sites were taken at baseline (T0), 3 weeks (T1), 3 months (T2) and 6 months (T3). Results 40 patients completed the study. Both groups showed a significant decrease in PPD, BOP, CAL, and number/percentage of residual pockets compared to baseline. However, no inter-group differences were noted. The test group showed a lower percentage of BOP at sites with plaque at T2 and T3. The microbiological analysis detected minimal proportion of L. reuteri in the periodontal pockets. An increase in health-related species such as Streptococcus and Actinomyces was observed at T1 in both groups. However, at T2 and T3 the biofilm composition returned to baseline levels. Conclusion In our cohort of patients, 3 weeks of bi-daily supplementation with lozenges containing L. reuteri in conjunction with a session of SPT did not provide any additional reduction in PPD or number/percentage of residual pockets, and did not have a long-lasting effect on the subgingival biofilm microbial composition. However, patients receiving the probiotic had less bleeding at sites with plaque. Clinical relevance: Whilst L. reuteri cannot be recommended as a standard adjunctive therapy in SPT, it can be considered to reduce BOP levels in patients with poor plaque control. microbiome probiotic eubiotic shift Limosilactobacillus reuteri supportive periodontal therapy guided biofilm therapy Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Aug, 2025 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Revision requested 08 Jun, 2025 Reviews received at journal 26 May, 2025 Reviews received at journal 20 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviewers agreed at journal 15 May, 2025 Reviewers agreed at journal 15 May, 2025 Reviewers invited by journal 15 May, 2025 Editor assigned by journal 13 May, 2025 Submission checks completed at journal 13 May, 2025 First submitted to journal 12 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6642765","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457954879,"identity":"e97453de-2a49-4ecd-9ab7-8d17988737e4","order_by":0,"name":"Magda Mensi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYJACCQjF2PgASPLwkaKl2QCkhY0ELQxsYAZBLbrtxy/e+MGwTc6c/3Bb5dccOxk2BuaHj27g0WJ2JqfYsofhtrHljMS227LbkoEOYzM2zsGn5UBOmgQPw+3EDTcY225LbmMGauFhk8ar5fybNMk/DLfrN5w/2FYsua2eCC030o9JA21JMDiQ2Mb4cdthYrS8YbaWMbhtuOFGYrM047bjPGzMhPxyPv3hzTcVt+UNzh9/+PHntmp7fvbmh4/xaQHGHTACDSBMZh4wiVc5CLA/gDMZfxBUPQpGwSgYBSMRAABJMkmszq7+VQAAAABJRU5ErkJggg==","orcid":"","institution":"Section of Periodontics, School of Dentistry, Department of Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy","correspondingAuthor":true,"prefix":"","firstName":"Magda","middleName":"","lastName":"Mensi","suffix":""},{"id":457954880,"identity":"5f371779-d80c-4029-97bb-b321bf6cabd7","order_by":1,"name":"Eleonora Scotti","email":"","orcid":"","institution":"Section of Periodontics, School of Dentistry, Department of Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy","correspondingAuthor":false,"prefix":"","firstName":"Eleonora","middleName":"","lastName":"Scotti","suffix":""},{"id":457954881,"identity":"c55d2e7c-3500-4d8e-8f03-be5b8670a800","order_by":2,"name":"Silvia Marchetti","email":"","orcid":"","institution":"Section of Periodontics, School of Dentistry, Department of Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Marchetti","suffix":""},{"id":457954882,"identity":"3d083e72-fd00-4998-855d-ff293c303cba","order_by":3,"name":"Annamaria Sordillo","email":"","orcid":"","institution":"Section of Periodontics, School of Dentistry, Department of Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy","correspondingAuthor":false,"prefix":"","firstName":"Annamaria","middleName":"","lastName":"Sordillo","suffix":""},{"id":457954883,"identity":"f46ef699-0c35-4275-9296-2ea3c3904ba2","order_by":4,"name":"Gianluca Garzetti","email":"","orcid":"","institution":"Section of Periodontics, School of Dentistry, Department of Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy","correspondingAuthor":false,"prefix":"","firstName":"Gianluca","middleName":"","lastName":"Garzetti","suffix":""},{"id":457954884,"identity":"47e13343-3231-4ca9-903c-e7b83d0c4cad","order_by":5,"name":"Stefano Calza","email":"","orcid":"","institution":"Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.","correspondingAuthor":false,"prefix":"","firstName":"Stefano","middleName":"","lastName":"Calza","suffix":""},{"id":457954885,"identity":"b5ba8e56-6f9d-4d2f-90b0-0ece5851b391","order_by":6,"name":"Mark J. Buijs","email":"","orcid":"","institution":"Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"J.","lastName":"Buijs","suffix":""},{"id":457954886,"identity":"3ebb1a4a-8a69-4c27-abb4-518b26732db2","order_by":7,"name":"Egija Zaura","email":"","orcid":"","institution":"Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam","correspondingAuthor":false,"prefix":"","firstName":"Egija","middleName":"","lastName":"Zaura","suffix":""},{"id":457954887,"identity":"cf267d0c-c2f1-475b-94cf-763ed29572ad","order_by":8,"name":"Bernd W. 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Complete periodontal assessment was performed including Pocket Probing Depth (PPD), Bleeding on Probing (BOP), Plaque index (PI), Clinical Attachment Loss (CAL) and Recession (REC). Two sites per patient with PPD\u0026thinsp;\u0026ge;\u0026thinsp;6 mm or PPD of 5 mm with bleeding on probing were selected in two different quadrants as test sites. A session of full-mouth debridement was provided at baseline (T0), and patients were randomized to receive a 3-weeks treatment with lozenges containing probiotic or placebo. Periodontal parameters and microbiological samples from the test sites were taken at baseline (T0), 3 weeks (T1), 3 months (T2) and 6 months (T3).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e40 patients completed the study. Both groups showed a significant decrease in PPD, BOP, CAL, and number/percentage of residual pockets compared to baseline. However, no inter-group differences were noted. The test group showed a lower percentage of BOP at sites with plaque at T2 and T3. The microbiological analysis detected minimal proportion of \u003cem\u003eL. reuteri\u003c/em\u003e in the periodontal pockets. An increase in health-related species such as \u003cem\u003eStreptococcus\u003c/em\u003e and \u003cem\u003eActinomyces\u003c/em\u003e was observed at T1 in both groups. However, at T2 and T3 the biofilm composition returned to baseline levels.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn our cohort of patients, 3 weeks of bi-daily supplementation with lozenges containing \u003cem\u003eL. reuteri\u003c/em\u003e in conjunction with a session of SPT did not provide any additional reduction in PPD or number/percentage of residual pockets, and did not have a long-lasting effect on the subgingival biofilm microbial composition. However, patients receiving the probiotic had less bleeding at sites with plaque.\u003c/p\u003e\u003ch2\u003eClinical relevance:\u003c/h2\u003e \u003cp\u003eWhilst \u003cem\u003eL. reuteri\u003c/em\u003e cannot be recommended as a standard adjunctive therapy in SPT, it can be considered to reduce BOP levels in patients with poor plaque control.\u003c/p\u003e","manuscriptTitle":"Clinical and Microbiological Effectiveness of Limosilactobacillus Reuteri in Supportive Periodontal Therapy: Randomized Clinical Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 18:42:44","doi":"10.21203/rs.3.rs-6642765/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-08T11:05:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-26T19:06:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-20T08:55:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4650814442194798015521929972153922940","date":"2025-05-16T18:52:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154941273255361499372759678262391955351","date":"2025-05-15T11:25:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183828680345764010117584055315227779469","date":"2025-05-15T07:15:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T07:01:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T13:42:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-13T13:35:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2025-05-12T04:24:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0b1721db-bc0c-4099-aa04-b0ed6e180e66","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:06:54+00:00","versionOfRecord":{"articleIdentity":"rs-6642765","link":"https://doi.org/10.1007/s00784-025-06508-w","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2025-08-26 15:57:23","publishedOnDateReadable":"August 26th, 2025"},"versionCreatedAt":"2025-05-19 18:42:44","video":"","vorDoi":"10.1007/s00784-025-06508-w","vorDoiUrl":"https://doi.org/10.1007/s00784-025-06508-w","workflowStages":[]},"version":"v1","identity":"rs-6642765","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6642765","identity":"rs-6642765","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}