## 4 Discussion  
For the replacement of missing teeth, osseo-integrated implants are one of the most frequently used treatment solutions, showing high efficacy, a positive long-term prognosis, and a survival rate ranging from 95% to 99% [37]. As the number of implants positioned rises, so does the frequency of relative complications leading to implant loss: loss of osseointegration; implant fracture; fracture of the screw connecting the abutment to the implant; fracture of the screw connecting the crown to the abutment (if it is a screw-retained prosthesis); peri-implant mucositis; and peri-implantitis [38]. The prevalence of peri-implant mucositis is higher than that of peri-implantitis: 80% of patients and 50% of sites respectively, compared with 28-56% of patients and 12-43% of sites [39]. Clinically, the risk factors for periodontitis can be considered an analogue for peri-implant disease; in particular, patients susceptible to periodontal disease appear to be more affected by peri-implant disease [40]. The pathogenesis appears to be related to the presence of a biofilm consisting of microorganisms, especially anaerobic Gram-, comparable to those found in periodontal disease; moreover, if periodontal pockets are present close to the implant site, they may act as foci of infection [41]. The proposed treatment of peri-implant disease is based on similar therapies followed in periodontal disease: non-surgical mechanical therapy (SRP) can be effective in treating mucositis, but the addition of topical antimicrobials increases the chance of successful treatment because reducing the bacterial load to allow healing is difficult to achieve by mechanical means alone, thus leading to bacterial recolonization [42]. Probiotics are the newest additional therapy and contain specific bacteria that have positive influences on health, including avoiding the side effects of antibiotics [43]. By modulating the local environment, symbiotic bacteria enable SRP efficiency [44]. To date, a few studies have been conducted to evaluate the effect of probiotics in peri-implant mucositis. They suggest that the oral and intestinal microbiota may be relevant to the development and treatment of mucositis, but a clear high-risk model has not yet been  
Figure 6: MMC values. \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline
**Group** & **Time** & **Mean** & **St Dev** & **Min** & **Median** & **Max** & **Significance \({}^{*}\)** \\ \hline Control (CHX) & T0 & 1.30 & 0.57 & 0.00 & 1.00 & 2.00 & A,C \\  & T1 & 1.00 & 0.56 & 0.00 & 1.00 & 2.00 & A,B \\  & T2 & 0.65 & 0.59 & 0.00 & 1.00 & 2.00 & B,D \\  & T3 & 0.60 & 0.68 & 0.00 & 0.50 & 2.00 & B,D \\ Trial (BPI) & T0 & 1.60 & 0.60 & 0.00 & 2.00 & 2.00 & C \\  & T1 & 1.00 & 0.65 & 0.00 & 1.00 & 2.00 & A,B,D \\  & T2 & 0.60 & 0.60 & 0.00 & 1.00 & 2.00 & B,D \\  & T3 & 0.50 & 0.51 & 0.00 & 0.50 & 1.00 & D \\ \hline \hline \end{tabular} \({}^{*}\) Use of various letters indicates significant differences between the two products (\(p<0.05\)).  
\end{table} 
Table 8: Descriptive statistics of marginal mucosal conditions (MMC). identified and no single probiotic formulation has emerged for this indication. Preliminary results are promising for the positive effects of _Lactobacillus_ species, particularly _L. reuteri_ in the treatment of peri-implant mucositis and _L. brevi CD2_ in the prevention of oral mucositis related to chemo/radiotherapy. Further studies are needed to address limitations but also to investigate the potential adjuvant role of prebiotics [45; 46]. Since there are no studies assessing postbiotics in implantology, the aim of this work was to evaluate the effect of a recently developed antioxidant-acting postbiotic-based gel in supplement to mechanical debridement to improve clinical values of peri-implant mucositis. The study's statistical null hypothesis was confirmed in part.