Assesment of changes in clinical and radiographic parameters following the application of local hyaluronic acid gel as an adjunct to minimally invasive non-surgical treatment of intraosseous defects

Recently, Minimally invasive non-surgical treatment (MINST) has emerged as a prominent approach fort he treatment of intraosseous defects. Hyaluronic acid (HA) plays an important role in inflammation and wound healing mechanisms. Furthermore, it has been reported as have clinically positive effects regarding periodontal tissue regeneration and treatment of periodontal disease. The aim of this study is to evaluate the clinical and radiographic effects of HA gel application as an adjunct to MINST in Stage III/IV periodontitis patients with intraosseous defects  3mm. A total of 36 patients were included in the study and randomly divided into two groups: a) MINST +HA (test; n=17) and b) MINST (control; n=19). Following supragingival debridement, subgingival application of 0,8 % HA gel was performed in the test group in addition to MINST treatment in the intraosseous defect areas. HA application was repeated at the 4th week after treatment. Probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), bleeding on probing (BOP), and plaque (P) measurements at the intraosseous defect area were recorded at baseline, 3rd months, and 6th months. In the study population, there was a significant decrease in the clinical parameters of PPD, CAL, BOP, and P (%) at 3 and 6 months compared to baseline in both the test and control groups (p < 0.05). When the changes in clinical parameters were compared between the groups, it was found that the test group had a significantly greater reduction in PPD and CAL values at 3 months compared to baseline (p < 0.05). However, there was no significant difference between the groups when the changes at 6 months were compared to baseline between the groups (p > 0.05). The test group showed less increase in GR measurements at 3rd and 6th months compared to baseline (p < 0.05). In both the test and control groups, there was a significant decrease in TDD, INFRA, and defect angle measurements at 6 months compared to baseline (p < 0.05). However, there was no statistically significant difference in the changes between the groups during the evaluated time intervals (p > 0.05). Within the limitations of our study, it was concluded that the additional use of 0,8% HA gel in the treatment of intraosseous defects resulted in positive improvements in clinical periodontal parameters. Therefore, it can be suggested that subgingival application of 0,8% HA gel as an adjunct to the MINST procedure can be utilized, especially for intraosseous defects where gingival recession is expected. Keywords: Minimally invasive, nonsurgical periodontal debridements, periodontitis, alveolar bone loss, hyaluronic acid.