Abstract
The aim of the present study was to evaluate the adjunctive effect of hyaluronic acid (HA) gel in the treatment of residual periodontal pockets over a 12-month period. Periodontal patients presenting at least one residual periodontal pocket 5–9 mm of depth in the anterior area were recruited from six university-based centers. Each patient was randomly assigned to subgingival instrumentation (SI) with the local adjunctive use of HA for test treatment or adjunctive use of local placebo for control treatment at baseline and after 3 months. Clinical parameters ( )probing depth (PD), bleeding on probing (BoP), plaque index (PI), recession (REC), clinical attachment level (CAL)) and microbiological samples for the investigation of the total bacterial count (TBC) and presence of specific bacterial species (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum) were taken at baseline and every 3 months, until study termination. PD was determined as the primary outcome variable. From a total of 144 enrolled, 126 participants (53 males, 73 females) completed the entire protocol. Both treatments resulted in statistically significant clinical and microbiological improvements compared to baseline. Although the local application of HA showed a tendency for better results, there was a lack of statistically significant differences between the groups.
Highlights
Periodontitis is still among the most globally prevalent oral diseases, despite the observed improvement during recent decades in countries with high incomes [1,2,3].If treated, disease progression can be stopped [4]
A total of 144 participants gave their consent to participate in the study
Bleeding on probing expressed as the percentage of patients presenting BOP at the treated site improved significantly, decreasing in both groups (HA: BOP0 = 77.4%, BOP12 = 37.7%; p < 0.001 and placebo: BOP0 = 67.2%, BOP12 = 23.8%; p < 0.001), it did not resolve completely
Summary
Periodontitis is still among the most globally prevalent oral diseases, despite the observed improvement during recent decades in countries with high incomes [1,2,3].If treated, disease progression can be stopped [4]. Only patients with residual periodontal pockets ≤4 mm after active periodontal therapy are more likely to present stability of clinical attachment level over a follow-up time of beyond 1 year [5,6]. The goals of periodontal therapy and subsequent maintenance should be to reduce or eliminate residual probing depths which are considered optimal ecological niches for the pathogenic microbiota whilst keeping the resistance and resilience of the patient at a high level [7]. In periodontitis patients with deep probing depths (≥6 mm) or complex anatomical surfaces (root concavities, furcations, infrabony pockets) Step 1 (adequate patient’s oral hygiene practices, professional elimination of supragingival biofilm and risk factor control) and Step 2 (elimination/reduction of supra and subgingival biofilm and calculus, with or without adjunctive therapies) may not lead to the achievement of the endpoints of therapy, and further treatment should be implemented, such as repeated subgingival instrumentation (SI) with or without adjunctive therapies or periodontal surgery [8]. In vitro studies confirmed that commercially available high-molecular-weight (MW) HA products are highly biocompatible and (a) in gingival tissues do not impair the healing process by prolonging inflammation or causing excessive mmP expression at the repaired site [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
