Local delivery of hyaluronan 0.8% as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A clinical and microbiological study

Abstract

Background:The purpose of this study was to assess the clinical and microbiological effects of the local and sub-gingival application of a hyaluronan gel on scaling and root planing (SRP) in the treatment of moderate generalized chronic periodontitis.Materials and Methods:In this split mouth study, 72 teeth in 18 patients with generalized chronic periodontitis with moderate severity were chosen for the study. Plaque samples were obtained by paper points at required intervals. Contra-lateral pairs of premolars and canine teeth in the maxilla or the mandible were selected to receive test treatment or serve as controls. Experimental jaw quadrants received sub-gingival administration of 0.2-ml 0.8% hyaluronan gel into selected sites following SRP and 1-week later. Clinical parameters were assessed at baseline, 1st, 4th, and 12th week. Colony-forming units (CFU) per milliliter were assessed at baseline, after SRP and after 2 weeks of drug insertion Student t-test and repeated measure ANOVA (RMANOVA) were used in this study. RMANOVA was used to find the significance in bleeding on probing (BOP) and plaque index (PI) and t-test for probing pocket depth (PPD) and clinical attachment level (CAL).Results:The results revealed that there was a significant reduction in BOP (P < 0.001) PI (P < 0.001), PPD (P < 0.001) and CAL (P < 0.001) were also observed in experimental jaw quadrant following SRP and insertion of 0.8% hyaluronan when compared with the control group. A statistically significant reduction of CFUs was also found (P < 0.001) in the experimental site when compared with the control site.Conclusion:Sub-gingival placement of 0.2-ml of 0.8% hyaluronan along with SRP resulted in a significant improvement in both clinical and microbiological parameters when compared with the control site.

Local Delivery of Hyaluronan as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis

“…The present study demonstrated a positive effect of subgingival hyaluronan application on dental plaque formation; the test group showed a significant lower mean plaque score as compared to the control group at 1st, 4th and 12th weeks. This is in accordance with studies conducted by Eick et al, 12 Pilloni et al, 13 Polepalle et al, 14 and Sapna et al, 15 who showed reductions in PI scores in patients with topical and intrasulcular hyaluronan gel application. Jentsch et al 5 suggested a beneficial effect of hyaluronan gel during the therapy of plaque-induced gingivitis proven by clinical and paraclinical variables.…”

To compare the effect of the local delivery of hyaluronan as an adjunct to scaling and root planing versus scaling and root planing alone in the treatment of chronic periodontitis

“…Even in studies wherein the modes of application of HA gel and the frequency differed in the treatment of chronic periodontitis patients, significant reductions in pocket depths were observed. [ 28 31 32 33 34 ]…”

“…They, however, did not find a statistically significant difference between the test and control groups. [ 13 27 28 31 34 35 ] This could be attributed to the vast difference in the study design such as the severity of the disease in the subjects, the concentration of the gel, and the mode of application, frequency.…”

Melatonin and Hyaluronic Acid in Periodontal Disease

“…Subgingival application of HA after full mouth SRP in chronic periodontis had beneficial effect observed, in several clinical studies, with overall improvements of periodontal tissues health [36]. Statistically significant reduction of BOP and PD, as compared to control was observed by Johannsen and co-workers, Polepalle and coworkers [46] and Al-Shammari and co-workers [47], after professional subgingival application of 0.8% HA gel, on patients with chronic periodontitis. Similar results were obtained by Rajan et al [48], Sahayata et al…”