Student Theses, Dissertations and Capstones

Document Type


Degree Name

Master of Science (M.S.) in Dentistry

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.


College of Dental Medicine

First Advisor

Saynur Vardar-Sengul

Second Advisor

Toshihisa Kawai

Third Advisor

Maria Hernandez

Publication Date / Copyright Date



Nova Southeastern University


Introduction: During the last decade, the results of several clinical studies suggested that oral probiotics may potentially improve oral health. The first study examining the effects of probiotics on oral health demonstrated that almost every patient with gingivitis, periodontitis or pregnancy gingivitis, had significant improvements in measurable periodontal indices when they were treated with a locally administered culture supernatant of a Lactobacillus acidophilus strain. This finding sparked several other studies to further examine the potential for treating oral diseases, such as, combating halitosis, oral candidiasis, and dental caries with probiotics. Of our interest, Fernandez et al. and Hollstrom et al. published their clinical studies investigating the effects of probiotics on peri-implant mucositis lesions and had conflicting results. In a recent study investigating the effect of Lactobacillus reuteri on peri-implantitis lesions, it was concluded that the oral probiotics together with mechanical debridement gave additional improvement for all clinical parameters. However, more studies are needed to confirm this finding as the majority of published studies explored the effects of probiotics on periodontitis and peri-implant mucositis lesions, very few focused specifically on peri-implantitis lesions. Therefore, the goals of this study were to examine the clinical, inflammatory and microbiological effects of oral probiotics when used as an adjunct in addition to non-surgical debridement in treating peri-implantitis lesions. Methods: A double blind pilot study was conducted between the test group (probiotics) versus the control group (placebo) as an adjunct to non-surgical treatment of peri-implantitis sites. Peri-implantitis is defined when there is a probing depth of 6mm or more with bleeding on probing and 3mm or more radiographic bone loss compared to radiographs when implants were placed. A full mouth non-surgical treatment was performed and peri-implantitis sites were debrided using titanium curettes. Subsequently, oral probiotics containing strains of S. salivarius K12, S. salivarius M18, L. reuteri and L. paracasei were given to the test group while the control group received placebo tablets. Subgingival plaque, gingival crevicular fluid/peri-implant crevicular fluid volume and clinical parameters such as probing depth,clinical attachment level, bleeding on probing plaque index and gingival index were recorded for analysis. Moreover, these data were collected from not only peri-implantitis sites of each subject but also from healthy and periodontitis sites of all patients. Microbiological testing was done by 16sRNA analysis and GCF/PICF analysis were done by ELISA. Statistical analyses were done by using One-way Anova. Results: There were no statistically significant differences for all clinical parameters comparing baseline to 90 days for the test and control groups at all sites. However, biologically, only probiotic group in peri-implantitis sites demonstrated statistically significant reduction after 90 days. Moreover, there were no statistical differences for MMP-9 or interleukin-1β. There was a statistically significance increase for P. gingivalis for peri-implantitis sites (p=0.04) for the probiotic group. There was statistically significant increase in commensal bacteria of the green, purple and blue complexes specifically C.concisus (p=0.028), A. graevenitzii (p=0.023) and Actinomyces species (p=0.015) in probiotic group in peri-implantitis sites compared to placebo. . Conclusions: Our findings suggest that adjunctive use of oral probiotics appeared to have limited effects on clinical parameters, however, biologically, they significantly decreased PICF TNF-α levels, a pro-inflammatory cytokine which is associated with periodontal and peri-implant breakdown. Furthermore, oral probiotics may help to shift the microbial flora towards commensal bacteria as it was shown to be statistically increased. in peri-implantitis sites. This suggests that oral probiotics may play a role in affecting the overall microbiota of the oral cavity shift towards a healthier and more symbiotic environment.




Oral probiotic supplementation, Non-surgical therapy, Peri-implantitis lesions



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