Treatment of Residual Periodontal Pockets Using a Hyaluronic Acid-Based Gel: A 12 Month Multicenter Randomized Triple-Blinded Clinical Trial

Pilloni, Andrea; Zeza, Blerina; Kuiš, Davor; Vražić, Domagoj; Domić, Tomislav; Olszewska-Czyż, Iwona; Popova, Christina; Kotsilkov, Kamen; Firkova, Elena; Dermendzieva, Yana; Orrù, Germano; Sculean, Anton; Prpić, Jelena

doi:10.3390/antibiotics10080924

Cited by 22 publications

(32 citation statements)

References 46 publications

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“…The clinical results mediated by xHyA indicated a substantial benefit, which was corroborated by both a recent RCT study and a case series [ 42 , 43 ]. Beyond the positive effects of xHyA unfolded in the surgical context, its adjunctive use in NSPT yielded inconsistent outcomes in clinical studies [ 44 , 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery—Retrospective Analysis of a Clinical Case Series

et al. 2022

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The comprehensive treatment of periodontitis stage 2 to 4 aims at the resolution of periodontal inflammation and “pocket closure”, which implies a residual probing depth of ≤4 mm and a negative BoP. However, supportive periodontal therapy (SPT) regularly leaves behind persistent periodontal pockets with 5 or more mm in residual PPD and sites that often re-colonize and re-infect. Various adjunctive options for subgingival instrumentation have been proposed to enhance the antimicrobial effects to better control the re-infection of these residual sites. The locally applied adjuncts, based on their anti-inflammatory effect, are sodium hypochlorite antiseptic cleaning gel and cross-linked hyaluronic acid (xHyA). Both recently moved into the focus of clinical research on non-surgical and surgical therapy for periodontitis. The surgical use of xHyA indicates regenerative potential, supporting periodontal regeneration. This case series retrospectively analyzes the clinical benefits of the consecutive flapless application of sodium-hypochlorite-based cleaning gel and xHyA at the SPT to achieve pocket closure, thereby reducing the need for periodontal surgery. In 29 patients, 111 sites received the treatment sequence. At 6-month re-evaluation, an overall PPD reduction exceeding 2 mm was achieved, associated with a similar CAL gain (2.02 mm); the bleeding tendency (BoP) was reduced by >60%. Pocket closure occurred in almost 25% of all the sites. Within their limits, the present data suggest that the proposed combined adjunctive treatment of residual active periodontal sites yielded significant improvement in the clinical parameters. Further studies in RCT format are required to confirm these observations.

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Section: Discussionmentioning

confidence: 99%

Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery—Retrospective Analysis of a Clinical Case Series

et al. 2022

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“…After three months of non-surgical periodontal therapy, differences in BOP and PPD reduction were clearly in favor of the HA-treated group [22]. Using adjunctively the gel formulation in residual pockets resulted in by trend (not statistically signi cant) better results vs. instrumentation alone after 12 months [23].…”

Section: Introductionmentioning

confidence: 90%

In-vitro activity of hyaluronic acid and human serum on periodontal biofilm and periodontal ligament fibroblasts

Zhu

Werdt

Zappalà

et al. 2023

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Objectives: A beneficial effect of cross-linked hyaluronic acid (cHA) on periodontal wound healing and regeneration has recently been demonstrated. The present in-vitro study was designed to obtain deeper knowledge on the effect of cHA when applied in the gingival sulcus (serum-rich environment) during non-surgical periodontal therapy. Materials and methods: The influence of cHA, human serum (HS) and cHA/HS on (i) a 12-species biofilm formation, (ii) the adhesion of periodontal ligament fibroblasts (PDLF) to dentine surface, (iii) the expression and secretion of interleukin-8 and (iv) the expression of receptors of HA in PDLF and gingival fibroblasts (GF) were evaluated. Results: At 4 h of biofilm formation, cHA and HS in combination (cHA/HS) slightly decreased the colony forming unit counts in biofilm whereas the metabolic activity of biofilm was reduced in all test groups (cHA, HS, cHA/HS) vs. control. At 24 h, the quantity of biofilm was reduced in all test groups vs. untreated control. The test substances did not affect adhesion of PDLF to dentin. HS increased the expression of IL-8 by PDLF and GF which was partially downregulated by cHA. HS and/or cHA promoted the expression of the HA receptor RHAAM in GF but not in PDLF. Conclusions: In summary, the present data indicate that serum neither negatively affect the activity of cHA against periodontal biofilm, nor had any unwanted influence on the activity of PDLF. Clinical relevance: These findings lend additional support for the positive effects of cHA on cells involved in periodontal wound healing, thus pointing to its potential use in non-surgical periodontal therapy.

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“…All of them were viewed as possible tools that could affect not only oxidative damage but also the inflammatory process and interfere with variable cellular signaling pathways [ 15 ]. Although the effects and biological activity of hyaluronic acid—including its antioxidant properties—have already been established in numerous in vivo and in vitro investigations and the level of scientific evidence is rather significant [ 16 , 17 ], there are no clinical trials that have assessed the effect of its addition to periodontal therapy on antioxidant capacity and the levels of oxidative stress markers. Therefore, we have decided to test the hypothesis that the use of hyaluronic acid as a local adjunct to non-surgical periodontal therapy will improve the levels of oxidative stress markers and the overall antioxidant capacity in healthy, non-smoking patients diagnosed with periodontitis.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Hyaluronic Acid Adjunctive Therapy of Periodontitis on Salivary Markers of Oxidative Stress: Randomized, Controlled Clinical Trial

et al. 2022

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Periodontitis is a common oral disease affecting the tooth-supporting tissues. Bacteria have been long viewed as the main causative factor in its development; however, many investigations have proved that aberrant immune and inflammatory response and the resulting misbalance between the damage caused by reactive oxygen species and the antioxidant capacity of tissues may be an underlying factor in disease progression that reduces healing potential. The objective of the current trial is to assess the outcomes of the addition of hyaluronic acid (HA) to standard non-surgical periodontal therapy (NST) on some major oxidative stress markers in saliva. HA-based gel designed for dental application was used and the measurements were taken after 3 months. HA adjunctive therapy had a significantly greater increase in markers with antioxidant properties as well as total antioxidant capacity compared to standard NST alone. Furthermore, clinically measured levels of gingival inflammation (bleeding on probing-BOP) and periodontal destruction (clinical attachment loss-CAL) were significantly correlated with these markers, and the correlation was negative. This investigation demonstrates that HA may indeed express antioxidant properties and improve the antioxidant capacity of periodontal tissues, thus improving the prognosis for the teeth and the results of periodontal therapy. Further investigations will be necessary to determine the duration of these effects over time.

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Treatment of Residual Periodontal Pockets Using a Hyaluronic Acid-Based Gel: A 12 Month Multicenter Randomized Triple-Blinded Clinical Trial

Cited by 22 publications

References 46 publications

Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery—Retrospective Analysis of a Clinical Case Series

Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery—Retrospective Analysis of a Clinical Case Series

In-vitro activity of hyaluronic acid and human serum on periodontal biofilm and periodontal ligament fibroblasts

The Influence of Hyaluronic Acid Adjunctive Therapy of Periodontitis on Salivary Markers of Oxidative Stress: Randomized, Controlled Clinical Trial

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