European Journal of Cardiovascular Medicine

Periodontal disease is a prevalent chronic inflammatory condition affecting the supporting structures of teeth, primarily caused by microbial biofilms. It leads to progressive attachment loss, alveolar bone resorption, and, if untreated, tooth loss (1). Scaling and root planing (SRP) remains the cornerstone of non-surgical periodontal therapy, aiming to reduce bacterial load and inflammation (2). However, mechanical debridement alone may not be sufficient in all cases, necessitating the use of adjunctive therapies to enhance treatment outcomes (3).

Antibiotics such as tetracycline have been widely used as adjuncts to SRP due to their antimicrobial properties and ability to inhibit matrix metalloproteinases, thereby reducing tissue destruction (4). Despite their effectiveness, concerns regarding antibiotic resistance and adverse effects have led to an increased interest in alternative therapies, including probiotics (5). Probiotics, which are live beneficial microorganisms, can inhibit pathogenic bacteria, modulate the host immune response, and promote oral microbiome balance, offering a promising non-antibiotic approach in periodontal therapy (6).

Several studies have explored the role of probiotics in managing periodontal diseases, with evidence suggesting their ability to reduce gingival inflammation, decrease probing pocket depth (PPD), and improve clinical attachment levels (CAL) (7). However, there is limited direct comparison between probiotics and tetracycline as adjuncts to SRP. Therefore, this study aims to evaluate and compare the effectiveness of probiotics and tetracycline in improving clinical periodontal parameters when used alongside SRP.

Study Design and Population

This randomized controlled clinical trial included 60 participants diagnosed with chronic periodontitis. The participants were selected based on predefined inclusion criteria, including individuals aged 25–55 years with probing pocket depths (PPD) of ≥4 mm and clinical attachment loss (CAL) of ≥2 mm. Exclusion criteria comprised individuals with systemic diseases affecting periodontal health, those who had received antibiotics or probiotics in the past three months, and smokers. Ethical approval was obtained from the institutional review board, and all participants provided written informed consent before enrollment.

Study Groups and Interventions

The participants were randomly allocated into three groups (n=20 per group):

• Group A (SRP + Probiotics): Underwent SRP and received a daily probiotic supplement containing Lactobacillus and Bifidobacterium species for 12 weeks.
• Group B (SRP + Tetracycline): Underwent SRP and received tetracycline (250 mg, twice daily) for 10 days.
• Group C (SRP alone): Underwent SRP without any adjunctive therapy.

All participants underwent thorough SRP using ultrasonic scalers and hand instruments. Oral hygiene instructions were provided to ensure adherence to standard care practices.

Clinical Parameters and Data Collection

Baseline and post-treatment assessments (at 12 weeks) were conducted by a calibrated examiner who was blinded to the group allocation. The following clinical parameters were recorded:

1. Plaque Index (PI): Evaluates plaque accumulation.
2. Gingival Index (GI): Measures gingival inflammation.
3. Probing Pocket Depth (PPD): Assesses the depth of periodontal pockets using a periodontal probe.
4. Clinical Attachment Level (CAL): Measures the extent of attachment loss.

Statistical Analysis

Data analysis was performed using SPSS software. The mean and standard deviation of clinical parameters were calculated for each group. Comparisons within groups were conducted using paired t-tests, while intergroup differences were analyzed using one-way ANOVA followed by post-hoc tests. Statistical significance was set at p<0.05.

Clinical Parameters at Baseline and 12 Weeks

A total of 60 participants completed the study, with no dropouts recorded. All three groups showed significant improvements in periodontal parameters after 12 weeks. However, the groups receiving adjunctive therapy (probiotics and tetracycline) exhibited greater reductions in plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) compared to the SRP-alone group.

Table 1 presents the mean values and standard deviations of clinical parameters at baseline and after 12 weeks. At baseline, there were no significant differences among the groups (p>0.05). After 12 weeks, Group A (SRP + probiotics) and Group B (SRP + tetracycline) showed a statistically significant reduction in PPD and CAL compared to Group C (SRP alone) (p<0.05).

Comparison Between Groups

Intergroup comparisons revealed that both probiotic and tetracycline groups had comparable improvements in clinical outcomes, with no significant difference between them (p>0.05). However, fewer adverse effects were reported in the probiotic group.

Table 1: Clinical Parameters at Baseline and After 12 Weeks

(p-values indicate significance in post-treatment differences among groups)

As shown in Table 1, both Group A and Group B exhibited significant reductions in PI, GI, PPD, and CAL after 12 weeks (p<0.05). However, Group C, which underwent SRP alone, showed lesser improvements in all parameters. This highlights the enhanced efficacy of adjunctive therapies, particularly probiotics, as a safer alternative to antibiotics in periodontal therapy.

The findings of this study suggest that both probiotics and tetracycline as adjuncts to scaling and root planing (SRP) significantly enhance periodontal health compared to SRP alone. The reduction in plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) was more pronounced in the adjunctive therapy groups, supporting previous research highlighting the benefits of probiotics and antibiotics in periodontal treatment (1,2).

Tetracycline has been widely used in periodontal therapy due to its antimicrobial properties and its ability to inhibit matrix metalloproteinases, which are involved in tissue breakdown (3). It has demonstrated effectiveness in reducing periodontal inflammation and attachment loss when used as an adjunct to SRP (4,5). In our study, patients in the tetracycline group showed significant improvements in periodontal parameters, with a notable reduction in PPD and CAL gain at 12 weeks. These findings align with previous studies that report tetracycline's ability to suppress periodontopathogens and modulate host immune responses (6,7). However, the increasing concern over antibiotic resistance and potential side effects, such as gastrointestinal disturbances and opportunistic infections, underscores the need for alternative therapies (8,9).

Probiotics have emerged as a promising non-antibiotic adjunct in periodontal therapy. They exert beneficial effects by competing with pathogenic bacteria, modulating the immune response, and enhancing epithelial barrier function (10,11). In our study, the probiotic group showed comparable improvements in clinical parameters to the tetracycline group, with a significant reduction in PPD and CAL gain. This is consistent with previous research indicating that probiotics, particularly Lactobacillus and Bifidobacterium species, can significantly reduce gingival inflammation and improve periodontal health (12,13). Furthermore, probiotics have been shown to enhance the colonization of beneficial bacteria in the oral cavity, thereby reducing the risk of recurrent periodontal disease (14).

In conclusion, both probiotics and tetracycline demonstrated significant improvements in periodontal health when used as adjuncts to SRP. Probiotics offer comparable clinical benefits to tetracycline while presenting a safer alternative with minimal side effects. Future studies should explore the long-term effects of probiotic therapy and its potential role in preventing periodontal disease recurrence.

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