Hyaluronic Acid in Managing Deep Residual Pockets in Stage III-IV Periodontitis: A Randomized Controlled Trial

Authors

Mohamad Adib Jaafar, Periodontal Specialist Clinic of Jalan Perak, Ministry of Health Malaysia, 11600, Penang, Malaysia.Follow
Esther Voo Vui Ching, Periodontal Specialist Clinic of Mak Mandin, Ministry of Health Malaysia, 13400, Penang, Malaysia.
Sharul Nisha Ali, Periodontal Specialist Clinic of Mak Mandin, Ministry of Health Malaysia, 13400, Penang, Malaysia.
Jeyanthi Subramaniam, Sungai Dua Dental Clinic, Ministry of Health Malaysia, 13800, Butterworth, Penang, Malaysia.
Yuhaniz Ahmad Yaziz, Periodontal Specialist Unit, Kota Setar Dental Specialist Clinic, Lebuhraya Darul Aman, Ministry of Health Malaysia, 05100, Kedah, Malaysia.

Abstract

Objective: The purpose of this study was to determine the adjunctive clinical effect of hyaluronic acid (HA) in the non-surgical treatment of subjects with residual pockets (≥ 6 mm) at the maintenance phase. Methods: 36 systemically healthy subjects in the periodontal maintenance phase were included in this 3-month randomized clinical trial. Subjects received a course of full-mouth, scaling and root debridement (SRD). In the test group (n = 18), HA 0.8% was applied subgingivally immediately after SRD. The control group (n = 18) was treated with SRD only. Subjects in both groups were required to apply HA 0.2% twice a day for 2 weeks. Clinical parameters collected at baseline and 3 months post-treatment were periodontal pocket depth (PPD), bleeding on probing (BOP), and clinical attachment level (CAL). Results: In both groups, all parameters were significantly reduced (p < 0.05) after treatment. Subjects treated with HA 0.8% showed a greater gain in mean CAL and higher percentage of ‘healthy pocket’ (PPD ≤ 3 mm) than the control group. However, no statistical difference was observed. Conclusion: The overall results show that treatment with HA 0.8% has a potential improvement in periodontal health.

References

1. Claffey N, Egelberg J. Clinical indicators of probing attachment loss following initial periodontal treatment in advanced periodontitis patients. J Clin Periodontol. 1995; 22(9):690-6.

2. Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Bragger U, Zwahlen M, Lang NP. Influence of residual pockets on progression of periodontitis and tooth loss: Results after 11 years of maintenance. J Clin Periodontol. 2008; 35(8):685-95.

3. Cobb CM. Non-su rgical pocket therapy: Mechanical. Ann Periodontol. 1996; 1(1):443-90.

4. Citterio F, Gualini G, Chang M, Piccoli GM, Giraudi M, Manavella V, et al. Pocket closure and residual pockets after non-surgical periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol. 2022; 49(1):2-14.

5. Litwiniuk M, Krejner A, Speyrer MS, Gauto AR, Grzela T. Hyaluronic acid in inflammation and tissue regeneration. Wounds. 2016; 28(3):78-88.

6. Dahiya P, Kamal R. Hyaluronic Acid: A boon in periodontal therapy. N Am J Med Sci. 2013; 5(5):309-15.

7. Eick S, Renatus A, Heinicke M, Pfister W, Stratul SI, Jentsch H. Hyaluronic acid as an adjunct after scaling and root planing: A prospective randomized clinical trial. J Periodontol. 2013; 84(7):941-9.

8. Shah SA, Vijayakar HN, Rodrigues SV, Mehta CJ, Mitra DK, Shah RA. To compare the effect of the local delivery of hyaluronan as an adjunct to scaling and root planing versus scaling and root planing alone in the treatment of chronic periodontitis. J Indian Soc Periodontol. 2016; 20(5):549-56.

9. Eliezer M, Imber JC, Sculean A, Pandis N, Teich S. Hyaluronic acid as adjunctive to non-surgical and surgical periodontal therapy: A systematic review and meta-analysis. Clin Oral Investig. 2019; 23(9):3423-35.

10. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH ,et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri- Implant Diseases and Conditions. J Periodontol. 2018; 89 Suppl 1:S173-82.

11. Silness J, Loe H. Periodontal Disease in Pregnancy. Ii. Correlation between Oral Hygiene and Periodontal Condtion. Acta Odontol Scand. 1964; 22:121-35.

12. Pilloni A, Zeza B, Kuis D, Vrazic D, Domic T, Olszewska-Czyz I, et al. Treatment of residual periodontal pockets using a hyaluronic acid-based gel: A 12 month multicenter randomized tripleblinded clinical trial. Antibiotics (Basel). 2021;10(8):924.

13. Lobato J, Dos Santos Vilhena MA, Izidoro C, Alves RC, Proenca L. Single application of 0.8% hyaluronic acid as a coadjuvant of nonsurgical treatment in nonsmoking patients with periodontitis: A split-mouth, randomized, controlled pilot clinical trial. J Indian Soc Periodontol. 2019; 23(6):545-8.

14. Karakostas P, Davidopoulou S, Kalfas S. Use of hyaluronic acid in periodontal disease treatment: A systematic review. J Contemp Dent Pract. 2022; 23(3):355-70.

15. Gontiya G, Galgali SR. Effect of hyaluronan on periodontitis: A clinical and histological study. J Indian Soc Periodontol. 2012; 16(2):184-92.

16. Sahayata VN, Bhavsar NV, Brahmbhatt NA. An evaluation of 0.2% hyaluronic acid gel (Gengigel (R)) in the treatment of gingivitis: A clinical & microbiological study. Oral Health Dent Manag. 2014; 13(3):779-85.

17. Thuy T. Nguyen HTH, Nam C. Huynh, Vu H.A. Dien, Thuy L. Vo. Hyaluronic Acid 0.2% application enhanced chronic periodontitis treatment in non-surgical phase. J Stomatol. 2021; 74(2):76-83.

18. Johannsen A, Tellefsen M, Wikesjo U, Johannsen G. Local delivery of hyaluronan as an adjunct to scaling and root planing in the treatment of chronic periodontitis. J Periodontol. 2009; 80(9):1493-97.

19. Tonetti MS, Muller-Campanile V, Lang NP. Changes in the prevalence of residual pockets and tooth loss in treated periodontal patients during a supportive maintenance care program. J Clin Periodontol. 1998; 25(12):1008-16.

20. Gupta S, Kediege SD, Gupta A, Jain K. Evaluation of Gengigel(R) application in the management of furcation with coronally advanced flap through surgical re-entry-a split mouth clinical study. J Clin Diagn Res. 2017; 11(1):ZC27-32.

21. Ostos-Aguilar BI, Pinheiro Furquim C, Muniz F, Faveri M, Meza-Mauricio J. Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: A systematic review and metaanalysis. Clin Oral Investig. 2023; 27(5):1923-35.

22. Pilloni A, Annibali S, Dominici F, Di Paolo C, Papa M, Cassini MA, Polimeni A. Evaluation of the efficacy of an hyaluronic acid-based biogel on periodontal clinical parameters. A randomizedcontrolled clinical pilot study. Ann Stomatol (Roma). 2011; 2(3-4):3-9.

23. Olszewska-Czyz I, Kralik K, Prpic J. Biomolecules in dental applications: Randomized, controlled clinical trial evaluating the influence of hyaluronic acid adjunctive therapy on clinical parameters of moderate periodontitis. Biomolecules. 2021; 11(10):1491.

Recommended Citation

Jaafar, M., Vui Ching, E., Ali, S., Subramaniam, J., & Ahmad Yaziz, Y. Hyaluronic Acid in Managing Deep Residual Pockets in Stage III-IV Periodontitis: A Randomized Controlled Trial. J Dent Indones. 2024;31(2): 119-124