Effects of Nutritional Supplements Alone or as an Adjunct to Nonsurgical Periodontal Therapy: A Systematic Review and Network Meta‐Analysis

Background: Nutritional supplements (NSs) have been introduced as an adjunct to nonsurgical periodontal therapy (NSPT) in recent years. The aim of the present study was to evaluate the clinical effectiveness of NSs as an adjunct to NSPT by a network meta-analysis (NMA). Methods: This study followed the PRISMA guidelines, and its protocol was registered with PROSPERO. We searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) were selected as outcomes. A comparative analysis of different interventions was performed by using a Bayesian NMA model. Quality assessment was performed using the RoB2.0 tool. Results: Seventy-nine studies were included, with seven types of NSs. Herbal antioxidants were the most effective in reducing BOP. VD and antioxidants + scaling and root planing (SRP) exhibited significant efficacy on alleviating CAL at 3-month (3 m) and 6-month (6 m) follow-up. Additionally, herbal-antioxidants + SRP, probiotic + SRP, and melatonin demonstrated good efficacy on ameliorating PI, GI, and PPD. Conclusions: Among the seven types of NSs identified in this NMA, some NSs exhibit relatively higher periodontal health benefits. However, evidence regarding the effectiveness of NSs as an adjunct to NSPT is still insufficient and warrants further high-quality clinical trials.