Evaluation of the effect of additional hyaluronic acid-based gel on anti-inflammatory and anti-oxidant levels in the surgical periodontal treatment of patients with periodontitis

Aim: Hyaluronic acid (HA) has recently been used as a local chemotherapeutic agent in periodontal treatments because it supports wound healing and periodontal regeneration. The aim of this study was to evaluate the effect of HA-based gel as an additional local chemotherapeutic agent to surgical periodontal treatment in patients with periodontitis on the levels of IL-6, IL-8, IL-10, IL-17A, TOS and TAS in gingival crevicular fluid (GCF) and clinical parameters. Materials and Methods: This split-mouth study included 18 patients (9 males, 9 females) with a mean age of 43.44±8.12 years diagnosed with Stage III Grade B or C periodontitis. The right and left quadrants of the 18 patients were randomly divided into two groups; Group 1:control group (open flap debridement (OFD)) (n=18), Group 2:test group (OFD+HA) (n=18). Plaque index (PI), gingival index (GI), bleeding index on probing (BPI), probing pocket depth (PPD), clinical attachment level (CAL) measurements were recorded and GCF samples were obtained at baseline (T0). After non-surgical periodontal treatment, patients underwent surgical periodontal treatment. During the operation, 0.8% HA gel was applied to the defect areas in addition to OFD in the test group and saline solution was applied in addition to OFD in the control group. Clinical parameter measurements and GCF collection were repeated before (TS-1), 1 month (TS-2) and 6 months (TS-3) after surgical periodontal treatment. Results: There was a statistically significant decrease in all clinical parameters after treatment (TS-1,2,3) compared to baseline in both groups in intragroup comparisons (p<0.05). Statistically significantly lower GCF IL-6, IL-8, IL-17A and TOS levels and higher GCF IL-10 and TAS levels were found after treatment (TS-1,2,3) compared to the T0 period (p<0.05). In intergroup comparisons, statistically significantly lower CAL values were determined in the test group compared to the control group in the TS-2 period (p<0.05). There were statistically significantly higher GCF IL-10 levels in the TS-2 and TS-3 periods and significantly lower GCF IL-17A levels in the TS-3 period in the test group compared to the control group (p<0.05), no significant difference was determined between the groups in GCF IL-6, IL-8, TAS and TOS levels during the time periods (p>0.05). Conclusion: This study has shown for the first time that HA use in addition to surgical periodontal treatment in patients with periodontitis provides a positive improvement in CAL increase and GCF IL-10 and IL-17A levels. Within the limitations of the data, our study suggests that the use of HA as a local chemotherapeutic agent in surgical periodontal treatment can effectively support periodontal wound healing and provide positive results in GCF cytokine levels. Keywords: Hyaluronic acid, Surgical periodontal treatment, Gingival crevicular fluid, Cytokines, Oxidative stress.