Hyaluronic Acid Gel as Adjunct to Scaling and Root Planing Versus Scaling and Root Planing Alone in Treatment of Intraosseous Defects in Chronic Periodontitis Patients
Authors: Gangadhar B. , Chandran Ajay , Malik Yasser R. , Singh Gautam , Abobaker Sally Hassan , Moawad Amira A. R. , Babu J. Suresh , Swarnalatha C. , Nayyar Abhishek Singh 
Published: March 2023

Context:
Wound healing and associated tissue regeneration process are significant to successful outcomes during periodontal therapy. Hyaluronic acid (HA) is one of the important promoting factors that facilitate cell migration and differentiation during this process.

Aim:
The aim of the present study was to evaluate the efficacy of HA as a therapeutic bone regenerant in conjunction with scaling and root planing in the treatment of intra-osseous defects in chronic periodontitis patients.

Settings and Design:
The present study was planned as a randomized controlled trial on chronic periodontitis patients aged between 25 and 55 years comprising 120 sites with clinically confirmed intrabony pockets ≥5 mm.

Materials and Methods:
The patients were allocated to two groups using simple randomization process as Group A, wherein mechanical disruption of plaque biofilm was followed by placement of HA gel (HA gel) and Group B, wherein scaling and root planing alone were used as a treatment modality. The clinical parameters recorded at baseline and on follow-up visits after 4 and 6 weeks of the procedure included gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL).

Statistical Analysis Used:
Statistical analysis was performed using IBM SPSS statistics 17 (Chicago, USA). A comparison of different parameters within the group was made using unpaired t-test, while a comparison between the groups was made using paired t-test. P < 0.05 was considered statistically significant.

Results:
On intragroup comparisons, for GI, there was seen a statistically significant decrease in the mean GI scores at different time intervals in both the groups (P < 0.001 for both Group A and Group B for baseline vs. 4th week and baseline vs. 6th week comparisons, while P = 0.04 for Group A and P = 0.008 for Group B for 4th week vs. 6th week comparisons). For PI, there was seen a statistically significant decrease in the mean PI values at different time intervals in Group A and B except from the 4th- to 6th-week interval. For PPD, there was seen a statistically significant decrease in the PPD at different time intervals in Group A (P < 0.001 for Group A for baseline vs. 4th-week and baseline vs. 6th-week comparisons, while P = 0.01 for 4th week vs. 6th-week comparison), though, for Group B, statistically significant only when compared from baseline versus 6th week (P = 0.006). For CAL, the results were statistically significant in the baseline versus 4th-week and baseline versus 6th-week interval while insignificant in the 4th-week to 6th-week interval in Group A while on the contrary, the results were statistically significant only in the baseline to 6th-week interval in Group B and insignificant in the baseline versus 4th week and 4th week to 6th-week interval. On intergroup analysis, the results were statistically significant for all the parameters at the 4th- and 6th-week interval (P < 0.001), though, insignificant at baseline.

Conclusion:
HA gel in conjunction with scaling and root planing aided regeneration of bone in intraosseous defects in chronic periodontitis patients, leading to significant improvement in the clinical parameters recorded.