Healing of Periodontal Suprabony Defects following Treatment with Open Flap Debridement with or without Hyaluronic Acid (HA) Application

Abstract

Background and Objectives: This randomized, double-arm, multicentric clinical trial aims to compare the clinical outcomes following the treatment of suprabony periodontal defects using open flap debridement (OFD) with or without the application of hyaluronic acid (HA). Materials and Methods: Sixty systemically healthy patients with at least two teeth presenting suprabony periodontal defects were randomly assigned with a 1:1 allocation ratio using computer-generated tables into a test (OFD + HA) or control group (OFD). The main outcome variable was clinical attachment level (CAL). The secondary outcome variables were changes in mean probing pocket depth (PPD), gingival recession (GR), full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS). All clinical measurements were carried out at baseline and 12 months. Results: Sixty patients, thirty in each group, were available for statistical analysis. The mean CAL gain was statistically significantly different (p < 0.001) in the test group compared with the control group (3.06 ± 1.13 mm vs. 1.44 ± 1.07 mm). PPD reduction of test group measurements (3.28 ± 1.14 mm) versus the control group measurements (2.61 ± 1.22 mm) were statistically significant (p = 0.032). GR changes were statistically significant only in the test group 0.74 ± 1.03 mm (p < 0.001). FMBS and FMPS revealed a statistically significant improvement mostly in the test group. Conclusions: Suprabony periodontal defects could benefit from the additional application of HA in conjunction with OFD in terms of improvement of the clinical parameters compared with OFD alone.

Keywords: hyaluronic acid; open flap debridement; periodontal pocket; periodontal regeneration; suprabony defects.

Figure 1

CONSORT diagram.

Figure 2

Illustration of test (a,b) and control (a1,b1) group cases: (a) intraoperative view of the defect with Hyadent (HA) application, (b) flap after suturing, (a1) intraoperative view of the defect, (b1) flap after suturing.

Figure 3

Graphic representation of clinical parameters changes. Abbreviations: OFD + HA—test group; OFD—control group.

Figure 4

Frequency distribution of clinical parameter changes (expressed as % of sites) at 12 months: (a) CAL-gain, (b) PPD—reduction, (c) GR-change. Abbreviations: CAL—clinical attachment level; PPD—probing depth; GR—gingival recession; test group—OFD + HA; control group—OFD.