Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis

The Use of Hyaluronic Acid in the Non-Surgical Treatment of Periodontitis-An Umbrella Review

Background: Periodontitis is a prevalent inflammatory condition that destroys periodontal tissues. Scaling and root planing (SRP) is the gold standard for non-surgical treatment; however, its efficacy may be limited in cases with complex dental issues. This umbrella review aims to evaluate the effectiveness of hyaluronic acid (HA) as an adjunct to scaling and root planing (SRP) in enhancing clinical outcomes for periodontitis management. Methods: A comprehensive review of five systematic reviews, including meta-analyses where available, was conducted to synthesize evidence on the adjunctive use of HA with SRP. The studies were evaluated using the AMSTAR-2 quality assessment tool to determine methodological rigor. Data on clinical parameters such as probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were extracted and analyzed. Results: The findings indicate that HA supplementation leads to moderate improvements in PD, CAL, BOP, GI, and PI compared to SRP alone. Notable reductions in PD and gains in CAL were observed, with some meta-analyses showing statistically significant benefits. However, the heterogeneity in HA concentrations (0.2-1.4%), application methods, treatment frequencies, and follow-up durations (1 week to 12 months) limits definitive conclusions. Additionally, HA did not significantly affect the reduction in P. gingivalis prevalence. Conclusions: The use of HA in conjunction with SRP shows promise in enhancing the efficacy of non-surgical periodontal therapy. However, the heterogeneity in the quality and methodologies of the studies indicates the necessity for high-quality, standardized randomized controlled trials to establish clear clinical guidelines for the application of HA in the treatment of periodontitis.

Comparision of crosslinked hyaluronic acid vs. enamel matrix derivative for periodontal regeneration: an 18-month follow-up randomized clinical trial

AIM

To compare the effects of 1.8% hyaluronic acid (HA) and enamel matrix derivative (EMD) on periodontal regeneration in patients with periodontal bone defects, using clinical and radiographic parameters as outcome measures.

MATERIALS AND METHODS

We included 53 patients with 53 intrabony defects in this study who were randomly assigned to either the HA (test) or EMD (control) groups. Clinical and radiographic parameters were evaluated at 6, 12, and 18 months after the surgery.

RESULTS

Clinical measurements at 6, 12, and 18 months after surgery demonstrated significant improvements in probing depth (PD), clinical attachment level (CAL), recession (REC), and bleeding on probing for both groups compared with baseline (p < 0.001). The EMD group exhibited the highest CAL gain of 2-3 mm at 6 months, observed in 14 of 26 (53.8%) defect sites. Conversely, the HA group demonstrated a CAL gain ≥ 4 mm at 18 months, observed in 13 of 27 (48.1%) defect sites. Radiographic assessments at 6, 12, and 18 months demonstrated significant improvements from baseline for both groups (p < 0.001).

CONCLUSION

We found significant clinical and radiographic benefits of HA and EMD at 18 months, with some limitations in effectiveness for specific intraosseous defects.

CLINICAL RELEVANCE

This study demonstrated that hyaluronic acid (HA), combined with minimally invasive techniques, enhances periodontal regeneration by improving PPD reduction, CAL gain, and radiographic bone filling, with cost-effectiveness, application, and bioavailability surpassing that of other biomaterials. Based on these results, HA can be considered a viable alternative to EMD in indicated cases.

CLINICAL TRIAL REGISTRATION NUMBER

clinicalTrial.gov - NCT04274244.

Management of a carcinoma in situ of the tongue margin, using a Nd:YAG laser, cross-linked hyaluronic acid (xHyA) gel and a porcine pericardium resorbable membrane: a case report

BACKGROUND

Oral tongue squamous cell carcinoma is the most prevalent cancer of the oral cavity. To date, the mainstay management for carcinoma in situ of the oral cavity is the surgical radical removal of the neoplastic tis-sue. This paper describes a new approach in the management of an in situ carcinoma of the tongue margin, treated surgically by the use of Nd:YAG laser, the application of cross-liked hyaluronic acid (xHyA) gel and the placement of a resorbable porcine pericardium membrane (PPM).

CASE PRESENTATION

The case involves a 49-years old male patient with no history of smoking and alcohol use, who presented a non-homogeneous leukoplakia of the right tongue border. The biopsy revealed high-grade lichenoid dysplasia, corresponding to severe epithelial dysplasia or carcinoma in situ (Tis), characterized by full-thickness dysplasia without stromal invasion.

CONCLUSIONS

The case shows that the combined use of Neodimium laser surgery, xHyA gel and PPM is a viable option for promoting soft tissue regeneration in the oral cavity, enabling excellent clinical results in terms of healing medium-sized surgical defects. In addition, compared with other options for the reconstruction of surgical defects of the tongue, the clinical use of the association between these two materials has several biological advantages due to the absence of donor sites and high patient tolerability.

Effect of hyaluronic acid on palatal wound healing: A systematic review

OBJECTIVES

To evaluate the efficacy of topically applied hyaluronic acid on wound healing (patient-reported outcomes and clinical healing) after a palatal autogenous gingival graft is harvested.

MATERIALS AND METHODS

A systematic search was performed in April 2024 in eleven electronic databases. Two investigators independently screened the references for inclusion. Outcomes of interest included postoperative pain, analgesic consumption, complete epithelialization, and color match, which were synthesized using narrative synthesis.

RESULTS

A total of 535 results were identified and eight articles were included in the systematic review. Hyaluronic acid use on the palatal donor site had a better response to healing and wound size compared to the control sites with no agent applied. Hyaluronic acid demonstrated a positive effect in the form of complete epithelialization, and color match, with improved patient-reported outcomes such as post-operative pain.

CONCLUSION

Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions.

CLINICAL RELEVANCE

Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions.

Hyaluronic Acid in Bone Regeneration: Systematic Review and Meta-Analysis

AIM

The aim of this systematic review and meta-analysis was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when hyaluronic acid (HA) was added and mixed with graft materials in bone regeneration.

MATERIALS AND METHODS

This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute of Health Research (registration number CRD42024530030). Electronic research was performed, and involved studies published up to 29 February 2024 using a specific word combination. The primary outcome was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when HA was added and mixed with graft materials in bone regeneration. The search resulted in 138 potential studies. Meta-analyses were performed using the fixed and random effects model to identify significant changes in new bone formation and in the remaining graft particles.

RESULTS

After screening procedures, only three randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. The effect size of HA in the new bone formation was not statistically significant at 95% CI (Z = 1.734, p-value = 0.083, 95 % CI -,399; 6516). The effect size of HA in the remaining graft particles was not statistically significant at 95% CI (Z = -1.042, p-value = 0.297, CI -,835; 255).

CONCLUSIONS

Within the limitations of the present systematic review and meta-analysis, the addition of HA to bone graft did not result in significant changes in bone regeneration procedures in terms of new bone formation and residues, even if the included studies showed encouraging and promising results.

Synergistic Effects of Shed-Derived Exosomes, Cu2+, and an Injectable Hyaluronic Acid Hydrogel on Antibacterial, Anti-inflammatory, and Osteogenic Activity for Periodontal Bone Regeneration

The primary pathology of periodontitis involves the gradual deterioration of periodontal tissues resulting from the inflammatory reaction triggered by bacterial infection. In this study, a novel drug for periodontal pocket injection, known as the Shed-Cu-HA hydrogel, was developed by incorporating copper ions (Cu2+) and Shed-derived exosomes (Shed-exo) inside the hyaluronic acid (HA) hydrogel. Suitable concentrations of Cu2+ and Shed-exo released from Shed-Cu-HA enhanced cell viability and cell proliferation of human periodontal ligament stem cells. Additionally, the Shed-Cu-HA demonstrated remarkable antibacterial effects against the key periodontal pathogen (Aa) owing to the synergistic effect of Cu2+ and HA. Furthermore, the material effectively suppressed macrophage inflammatory response via the IL-6/JAK2/STAT3 pathway. Moreover, the Shed-Cu-HA, combining the inflammation-regulating properties of HA with the synergistic osteogenic activity of Shed-exo and Cu2+, effectively upregulated the expression of genes and proteins associated with osteogenic differentiation. The experimental findings from a mouse periodontitis model demonstrated that the administration of Shed-Cu-HA effectively reduced the extent of inflammatory cell infiltration and bacterial infections in gingival tissues and facilitated the regeneration of periodontal bone tissues and collagen after 2 and 4 weeks of injection. Consequently, it holds significant prospects for future applications in periodontitis treatment.

From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials

Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.

Hyaluronic acid in Dentoalveolar regeneration: Biological rationale and clinical applications

Background

Hyaluronic acid (HA) is found in different locations in the periodontium, including mineralized tissues (i.e., cementum and alveolar bone) and non-mineralized tissues (i.e., gingiva and periodontal ligament). In addition, it seems to play an essential part in regulating the underlying mechanisms involved in tissue inflammatory reactions and wound healing. HA has the potential to regulate periodontal tissue regeneration and treat periodontal disease.

Aim

The current review of the literature was conducted to assess how HA plays its part in periodontal therapy and examine the contemporary literature's viewpoint on its use in periodontal regeneration.

Conclusion

HA has a multifunctional character in periodontal regeneration, and healing and appears to provide promising outcomes in different periodontal regenerative applications.