Evaluation of the effectiveness of the use of hyaluronic acid based gel combined with the coronally advanced flap technique in the treatment of gingival recession

Aim: Hyaluronic acid (HA) has been suggested as a local chemotherapeutic agent in periodontal treatments due to its role in wound healing and periodontal regeneration. The aim of this study is to evaluate the effect of HA use in addition to the coronally advanced flap (CAF) technique in type1 gingival recession; postoperative morbidity and clinical parameters and patients satisfaction analysis at baseline and 6 months. Materials and Methods: This split-mouth study included 20 patients (9 males, 11 females) aged 25-65 years with bilateral Type I gingival recession in the maxilla. The right and left defect areas of the 20 patients were randomly divided into two separate groups. The control group received CAF (n=20), and the test group received CAF+HA (n=20). Pre-treatment plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), vertical recession depth(VRD), horizontal recession width (HRW), gingival thickness (GT), attached gingiva (AG), and keratinized gingival width (KGW) were recorded. Additionally, a satisfaction analysis including patient-based comfort (PBC), aesthetic (PBA), and sensitivity (PBS) scores was conducted. During the operation, a 0.8% HA gel was applied to the defect areas in the test group in addition to CAF, while saline was applied to the control group in addition to CAF. Pain, bleeding, and edema scores and the amount of pain killer were recorded during the 9-day postoperative period. Clinical parameter measurements and patient satisfaction analyses were repeated 6 months after surgical treatment. Results: When intragroup comparisons were evaluated, statistically significant improvements were found in clinical parameters including PPD, CAL, VRD, HRW, GT, AG and KGW and in patient satisfaction analysis at 6 months compared to baseline in both groups (P<0.05). In the intragroup evaluation, there was no significant difference in baseline and 6th month postoperative PI values in both groups, when examined in terms of GI values, there was no significant difference in the test group (P>0.05), while a significant increase was observed in the control group (P>0.05). In the comparison intergroups, it was determined that there was a significantly greater increase in the only PBC values in the test group compared to the control group post-op 6th month (P<0.01), while no significant difference was detected in other clinical parameters and patient satisfaction analysis results (P>0.01). Conclusion: Our study, for the first time in the literature, has shown that the application of HA in addition to CAF increases patient comfort scores at 6 months post-op. According to the results of our study, it can be suggested that the application of HA additionally to CAF may reduce the presence of gingival inflammation and also improve patient comfort scores in the postoperative period, but it does not have an additional effect on tissue healing after periodontal surgery. Keywords: Hyaluronic acid, gingival recession, coronally advanced flap, wound healing, split mouth design.