Adjunctive use of Hyaluronic Acid in non-surgical periodontal therapy: A Systematic review and Meta-analysis.

Abstract

Introduction and objectives: Clinical studies have shown that adjunctive use of hyaluronic acid (HA) as part of non-surgical periodontal treatment (NSPT) has led to favourable clinical outcomes. However, no systematic review and meta-analysis has been carried out recently and technical and patient factors have not been previously explored. Therefore, the aim of this systematic review and meta-analysis is to evaluate the clinical effects of topical- HA as an adjunct to NSPT on probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) in periodontitis patients.

Study selection and sources: Systematic literature searches using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) approach identified clinical studies involving randomized controlled trials (RCTs) and split-mouth designs involving adult periodontitis. The searches were performed across six databases (PubMed, Embase, Medline, Cochrane, Web of Science, Scopus, and Google Scholar).

Data: Of the 1479 articles identified from the initial searches, a total of 23 were included in this systematic review, and 12 studies were included in the meta-analysis and sub-group analyses. Based on the included studies, HA adjunctive therapy showed improvements in PD reduction (WMD of -0.46, 95% Confidence Interval CI: -0.89 to -0.04, P= 0.04), CAL gain (WMD of -0.35, 95% CI: -0.61 to -0.09, P=0.01), and BoP reduction (WMD of -0.38, 95% CI: -0.78 to 0.01, P=0.06). However, due to the heterogeneity of the included studies, further evidence were needed to support the improvement of HA adjunctive therapy outcomes due to wider prediction intervals (PD reduction 95% prediction interval, PI: -1.95 to 1.03; CAL enhancement 95% PI -1.11 to 0.42; BoP reduction 95% PI -1.35 to 0.59)Higher HA concentrations (0.8%)showed more pronounced PD reduction. The overall quality of the included studies were moderate using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment tool.

Conclusion: Although topical HA application may provide additional benefits when used with NSPT, the limited number of studies, risk of bias, heterogeneity and moderate quality of evidence indicate that further research is warranted to confirm these findings and establish more definitive clinical guidelines.

Clinical significance: HA showed promise as an adjunctive treatment in enhancing the clinical outcomes following NSPT.