From Dysbiosis Control to Ecological Repair: Postbiotics, Precision Microbiome Modulation, and Host-Resolution Strategies in Contemporary Periodontology: A Systematic Review
Mehmet Murat Taskan
*
Department of Periodontology, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkiye.
Ozkan Karatas
Department of Periodontology, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkiye.
Tugce Yapisoglu
Department of Periodontology, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkiye.
Ali Firat Basutcu
Department of Periodontology, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkiye.
*Author to whom correspondence should be addressed.
Abstract
Background: Periodontitis is a biofilm-mediated and host-modulated inflammatory disease in which dysbiosis, epithelial barrier injury, osteoimmune activation, and incomplete resolution of inflammation interact to sustain tissue destruction.
Objective: This systematic review evaluated evidence on postbiotics, precision microbiome modulation, and host-resolution strategies as adjuncts to established periodontal care.
Methods: A reproducible search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted for publications available up to 15 June 2026 using terms related to periodontitis, dysbiosis, probiotics, postbiotics, complement inhibition, specialised pro-resolving mediators, biomarkers, and precision periodontology. Eligible sources included clinical guidelines, systematic reviews, randomised or early-phase clinical trials, and mechanistic studies directly relevant to periodontal dysbiosis or host modulation. Evidence was synthesised qualitatively because interventions and outcomes were heterogeneous.
Results: Thirty-five publications were included. Conventional mechanical biofilm disruption and risk-factor control remain the foundation of treatment. Probiotic evidence shows modest and strain-dependent adjunctive benefits. Postbiotics are biologically plausible because inanimate microbial cells, cell components, and associated metabolites may affect biofilm behaviour, epithelial barrier integrity, and inflammatory signalling, but direct periodontal clinical evidence remains limited. Complement C3 inhibition, specialised pro-resolving mediators, NLRP3 modulation, and biomarker-guided patient selection provide promising translational directions.
Conclusion: The evidence supports a cautious mechanism-matched adjunctive model rather than replacement of guideline-based periodontal therapy. Robust manufacturing standards, verified product characterisation, risk-of-bias reporting, and adequately powered randomised trials are required before routine clinical implementation.
Keywords: Periodontitis, oral microbiome, dysbiosis, postbiotics, probiotics, host modulation, NLRP3 inflammasome, RANKL/OPG, precision periodontology