Hyaluronic Acid (ha)

Hyaluronic acid is a naturally occurring non-sulfated polysaccharide of the glycosaminoglycan family of the extracellular matrix of connective tissue, synovial fluid, and other tissues. 1,2 Synthesis of HA take place in the cell membranes of most of the body cells then secreted into the extracellular space. HA also produced by fibroblasts in the presence of endotoxins. It is a key component in the wound-healing process in both calcified and noncalcified tissues. HA preparations used as fillers have been manufactured from bacterial or animal sources and their clinical effect typically lasts 6-12 months, HYADENT BG is a new biodegradable non-animal based clear hyaluronic acid gel tissues.1

Many in vitro and animal studies reported encouraging results with HA, specifically with its positive effects on fibroblasts, bone regeneration, and wound healing.3,4 HA acts as an anti-inflammatory5,6 and as possible treatment option in osteoarthritis7 and as a soft-tissue filler.8 In dentistry, HA has shown a positive effect with plaque-induced gingivitis regarding the reduction of plaque and the sulcus bleeding of patients.9,10 Only in a few studies has HA been applied as an adjunct to SRP in non-surgical treatment of periodontitis. Johannsen et al.11 showed that after subgingival application of 0.8% HA gel immediately after SRP and 7 days later the bleeding on probing (BOP) and probing depth (PD) were significantly reduced. However, Xu Y et al.12 reported no influence of 0.2% HA gel application after SRP on clinical parameters after 6 and 12 weeks in chronic periodontitis patients

Locally applied high molecular HyA has also been shown to stimulate differentiation and migration of mesenchymal and muscular cells in vivo.13 A recent clinical study14 showed that osteoconduction is more efficient in autogenous bone graft mixed with HA compared to autogenous bone graft alone. A Medline search including the key words ‘‘periodontitis’’, “extraction socket healing” and ‘‘hyaluronic acid’’ showed insufficient results.

The beneficial effect of a hyaluronan-containing gel as adjunctive to non-surgical periodontal therapy in plaque induced gingivitis is reported by clinical and paraclinical variables.15. However, the possible effect of HA in the treatment of periodontal diseases is inconclusive due to a large variability in the available literature.16 Thus, the present study aimed to assess clinically and radiographically, extraction socket healing using HA and evaluate the effect of HA with scaling and root planing in the periodontal treatment of patient with moderate to advanced chronic periodontitis and to compare it with scaling and root planing alone.