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Axe A, Patel N, Qaqish J, Ling MR, Araga M, Parkinson C, Goyal CR. Efficacy of an experimental toothpaste containing sodium bicarbonate, sodium hyaluronate and sodium fluoride on gingivitis. BMC Oral Health 2024; 24:209. [PMID: 38336635 PMCID: PMC10858478 DOI: 10.1186/s12903-024-03981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Gingivitis is driven by plaque accumulation and, if left untreated, can progress to irreversible periodontitis. For many, the mechanical action of toothbrushing does not achieve adequate plaque control. The aim of this study was to investigate whether twice-daily use of a toothpaste containing 0.2% high molecular weight (HMW) sodium hyaluronate with 67% sodium bicarbonate and 0.221% sodium fluoride (experimental toothpaste) could improve gingival health compared with a regular fluoride toothpaste (negative control). The study also assessed whether the experimental toothpaste could provide additive gingival health benefit over a toothpaste containing only 67% sodium bicarbonate and 0.221% sodium fluoride (positive control). METHODS This was a single-center, examiner-blinded, randomized, clinical study in healthy adults with mild-to-moderate gingivitis. At baseline, after abstaining from toothbrushing for 12 h, prospective participants underwent oral soft tissue (OST) and oral hard tissue examination followed by assessments for gingival inflammation (Modified Gingival Index [MGI]), gingival bleeding (Bleeding Index [BI]), and supra-gingival plaque (Turesky Plaque Index [TPI]). Eligible participants were stratified by gender and baseline number of bleeding sites (low: <45; high: ≥45 bleeding sites). Following randomization, participants underwent prophylactic dental treatment. Participants received a full OST examination, MGI, BI and TPI assessments after 3 days, 1, 2 and 6 weeks of product use. RESULTS In total, 110 participants were screened for study entry and all were randomized to receive one of three toothpastes (experimental: sodium hyaluronate, sodium bicarbonate, sodium fluoride; positive control: sodium bicarbonate, sodium fluoride; negative control: regular fluoride toothpaste). For all measures, significant improvements were observed in participants receiving either sodium bicarbonate-containing toothpaste (experimental or positive control) compared with the regular fluoride toothpaste (negative control) at week 6. No significant difference was observed in any assessment or visit comparing the experimental toothpaste with the positive control. CONCLUSIONS Both the experimental and the positive control toothpastes demonstrated clinically relevant improvements in gingival health compared with a regular fluoride toothpaste (negative control). However, no additional gingival health improvement was observed for the experimental toothpaste compared with the positive control, therefore, no additional gingival health benefit can be attributed to the inclusion of sodium hyaluronate in this formulation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04737538 (04/02/2021).
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Affiliation(s)
- Alyson Axe
- Haleon, St George's Avenue Weybridge, Surrey, ODE, KT13, UK.
| | - Nisha Patel
- Haleon, St George's Avenue Weybridge, Surrey, ODE, KT13, UK
| | | | - Martin R Ling
- Haleon, St George's Avenue Weybridge, Surrey, ODE, KT13, UK
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Ramanauskaite E, Machiulskiene V, Shirakata Y, Dvyliene UM, Nedzelskiene I, Sculean A. Clinical evaluation of sodium hypochlorite/amino acids and cross-linked hyaluronic acid adjunctive to non-surgical periodontal treatment: a randomized controlled clinical trial. Clin Oral Investig 2023; 27:6645-6656. [PMID: 37740107 PMCID: PMC10630230 DOI: 10.1007/s00784-023-05271-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES To compare the clinical outcomes obtained with either mechanical subgingival debridement in conjunction with a sodium hypochlorite and amino acids containing gel followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with mechanical debridement alone. MATERIALS AND METHODS Fourty-eight patients diagnosed with stages II-III (Grades A/B) generalised periodontitis were randomly treated with either scaling and root planing (SRP) (control) or SRP plus adjunctive sodium hypochlorite/amino acid and xHyA gels (test). The primary outcome variable was reduction of probing depth (PD), while changes in clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were secondary outcomes. The outcomes were assessed at baseline, at 3 and 6 months following therapy. RESULTS All patients completed the 6 months evaluation. At 6 months, the test group showed statistically significantly better results in terms of mean PD reduction (2.9 ± 0.4 vs 1.8 ± 0.6 mm, p < 0.001). Similarly, mean CAL gain was statistically higher in the test group compared to the control one (test: 2.6 ± 0.5 vs control: 1.6 ± 0.6 mm, p < 0.001). Mean BOP decreased from 81.8 ± 16.2% to 48.9 ± 14.5% in control (p < 0.001) and from 83.2 ± 15.5% to 17.6 ± 11.5% in test (p < 0.001) groups with a statistically significant difference favouring the test group (p < 0.001). Mean PI scores were reduced statistically significantly in both groups (from 38.8 ± 26% to 26.5 ± 20.5% in control (p = 0.039) and from 60.6 ± 10.9% to 12.7 ± 8.9% in test group (p < 0.001)), with a statistically significant difference between the groups (p < 0.001). The number of moderate pockets (4-6 mm) were reduced from 1518 (41.2%) to 803 (22.6%) in the control and from 1803 (48.6%) to 234 (7.7%) in the test group with a statistically significant difference between the groups (p < 0.001), while the number of deep pockets (≥ 7 mm) changed from 277 (7.6%) to 35 (1.0%) in the control and from 298 (8.7%) to 4 (0.1%) in test group (p = 0.003). CONCLUSION Within their limits the present data indicate that: a) both treatments resulted in statistically significant improvements in all evaluated clinical parameters, and b) the adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA to SRP yielded statistically significantly higher improvements compared to SRP alone. CLINICAL RELEVANCE The combination of sodium hypochlorite/amino acid and xHyA gels to subgingival mechanical debridement appears to represent a valuable approach to additionally improve the outcomes of non-surgical periodontal treatment. Clinical Trial Registration Number NCT04662216 (ClinicalTrials.gov).
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Affiliation(s)
- Egle Ramanauskaite
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu 2, 50103, Kaunas, Lithuania.
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu 2, 50103, Kaunas, Lithuania
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Urte Marija Dvyliene
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu 2, 50103, Kaunas, Lithuania
| | - Irena Nedzelskiene
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu 2, 50103, Kaunas, Lithuania
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Miglani A, Vishnani R, Reche A, Buldeo J, Wadher B. Hyaluronic Acid: Exploring Its Versatile Applications in Dentistry. Cureus 2023; 15:e46349. [PMID: 37920632 PMCID: PMC10618852 DOI: 10.7759/cureus.46349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Hyaluronic acid (HA) a polysaccharide present in many areas of the body like the synovium of synovial joints, and connective tissues which have high regenerative and biocompatible properties has been an area of interest since recent times in dentistry. Several research papers and review articles were studied in the Pubmed database to formulate this review article. The main aim of this article is to demonstrate various applications of HA in different branches of dentistry. The PubMed database was searched for keywords "Hyaluronic acid AND periodontics," "Hyaluronic acid AND oral and maxillofacial surgery," "Hyaluronic acid AND oral medicine," "Hyaluronic acid AND orthodontics," "Hyaluronic acid AND endodontics," and "Hyaluronic acid AND aesthetic dentistry" which resulted in six, 296, 83, 86, 40, and 49 articles, respectively. The most relevant and informative articles were selected and studied for this review article. This review article will also help people to gain knowledge about the future aspects of the use of HA in dentistry and also motivate clinicians and new-generation dentists to inculcate the HA's use in their respective practice in dentistry.
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Affiliation(s)
- Abhinn Miglani
- Department of Periodontology and Oral Implantology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rozina Vishnani
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences Sharad Pawar Dental College, Wardha, IND
| | - Amit Reche
- Department of Public Health Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Janhavi Buldeo
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhinika Wadher
- Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ebrahimi R, Khorshidi H, Boroumand R, Azadikhah A, Haddadi P, MScD D. Evaluation of the Effect of Hyaluronic Acid Injection on the Reconstruction of Reduced Interdental Papillae in Patients Referred to Shiraz School of Dentistry. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2023; 24:305-311. [PMID: 37727351 PMCID: PMC10506141 DOI: 10.30476/dentjods.2022.94766.1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/12/2022] [Accepted: 08/24/2022] [Indexed: 09/21/2023]
Abstract
Statement of the Problem The occurrence of papillary defects adjacent to teeth or dental implants causes both the dental staff and the patients to be concerned about the esthetic issues. Interdental papilla reconstruction surgery is one of the most difficult and unpredictable mucogingival surgeries. Purpose The present study aimed to investigate the efficacy of hyaluronic acid injection in the reconstruction of the interdental papilla. Materials and Method This clinical trial study was conducted on four patients with 20 deficient interdental papillae who met the inclusion criteria. At first, local anesthesia was applied. Afterward, 0.2 mL of 1.6% hyaluronic acid (HA) gel was injected (at the tip of the papilla and 2-3 mm below the tip of the papilla) three times every two weeks. At baseline, three, and six months later, clinical photography was taken under standard conditions. The papilla height (the distance between the interdental papilla tip and the basis), black triangle area, and the distance between the interdental papilla tip and contact point of adjacent teeth were all measured using Image J software. Results The effectiveness of using HA gel in reducing the black triangle area was 85.06%. Furthermore, the papilla length increased by 70.256% while contact to papilla distance decreased by 83.026%. At different times, the values of the studied variables in the three levels were significantly different (p< 0.05). Conclusion Injection of HA with 1.6% concentration at two points of the interdental papilla was effective in interdental papilla reconstruction at the aesthetic zone, especially in long-term, follow-ups (especially 6 months).
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Affiliation(s)
- Reihaneh Ebrahimi
- Dept. of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Khorshidi
- Dept. of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rabieh Boroumand
- Dept. of Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Azadikhah
- Dept. of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pardis Haddadi
- Dept. of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dmd MScD
- Dept. of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Dept. of Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Diehl D, Friedmann A, Liedloff P, Jung RM, Sculean A, Bilhan H. Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery-Retrospective Analysis of a Clinical Case Series. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6508. [PMID: 36233855 PMCID: PMC9571901 DOI: 10.3390/ma15196508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
The comprehensive treatment of periodontitis stage 2 to 4 aims at the resolution of periodontal inflammation and “pocket closure”, which implies a residual probing depth of ≤4 mm and a negative BoP. However, supportive periodontal therapy (SPT) regularly leaves behind persistent periodontal pockets with 5 or more mm in residual PPD and sites that often re-colonize and re-infect. Various adjunctive options for subgingival instrumentation have been proposed to enhance the antimicrobial effects to better control the re-infection of these residual sites. The locally applied adjuncts, based on their anti-inflammatory effect, are sodium hypochlorite antiseptic cleaning gel and cross-linked hyaluronic acid (xHyA). Both recently moved into the focus of clinical research on non-surgical and surgical therapy for periodontitis. The surgical use of xHyA indicates regenerative potential, supporting periodontal regeneration. This case series retrospectively analyzes the clinical benefits of the consecutive flapless application of sodium-hypochlorite-based cleaning gel and xHyA at the SPT to achieve pocket closure, thereby reducing the need for periodontal surgery. In 29 patients, 111 sites received the treatment sequence. At 6-month re-evaluation, an overall PPD reduction exceeding 2 mm was achieved, associated with a similar CAL gain (2.02 mm); the bleeding tendency (BoP) was reduced by >60%. Pocket closure occurred in almost 25% of all the sites. Within their limits, the present data suggest that the proposed combined adjunctive treatment of residual active periodontal sites yielded significant improvement in the clinical parameters. Further studies in RCT format are required to confirm these observations.
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Affiliation(s)
- Daniel Diehl
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Institute of Pharmacology and Toxicology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Anton Friedmann
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Pheline Liedloff
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Rico Marvin Jung
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland
| | - Hakan Bilhan
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
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Ghasemi S, Torab Z, Shirmohammadi A, Babaloo A, Johari R, Farhadi F, Mobasseri M, Mohammadi H. Evaluation of the effect of coenzyme Q10 supplementation along with scaling and root planing (SRP) on periodontal and gingival indices in controlled diabetic patients. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2022; 14:32-37. [PMID: 35919443 PMCID: PMC9339722 DOI: 10.34172/japid.2022.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/02/2022] [Indexed: 11/09/2022]
Abstract
Background. This clinical trial evaluated the effect of coenzyme Q10 supplementation along with scaling and root planing (SRP) on periodontal and gingival indices in controlled diabetic patients. Methods. Forty-two diabetic patients (controlled type), referred to the Department of Periodontics with chronic periodontitis and eligible for the study, were included in the study. Patients suffering from chronic periodontitis with a probing pocket depth of ≥5 mm in different quadrants of the oral cavity with radiographic evidence of bone loss were included in the present randomized, double-masked, placebo-controlled clinical trial. The subjects were instructed to take one capsule of coenzyme Q10 or a placebo every day for 30 days following SRP. Clinical parameters, i.e., plaque index (PI), gingival index (GI), bleeding on probing (BOP), clinical attachment level (CAL), and probing pocket depth (PPD), were recorded at baseline and four weeks after treatment by two masked and calibrated examiners. The study results were reported as (mean ± standard deviations) and frequencies (percentages). Results. One month after the intervention, PPD, CAL, BOP, and PI indices in the intervention group were significantly lower than those in the control group. One month after the intervention, the GI was similar in both groups. A significant decrease was observed in the GI in both groups after the intervention. Conclusion. The results of the present study showed that Q10 orally with scaling and root planing in patients with controlled diabetes with chronic periodontitis might accelerate the treatment process and significantly reduce the pocket depth.
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Affiliation(s)
- Shima Ghasemi
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Torab
- Department of Pediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Adileh Shirmohammadi
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Babaloo
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farrokh Farhadi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mobasseri
- Department of Internal Medicine, School of Medicine, Endocrine Research Center, Imam Reza Medical Research & Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamidreza Mohammadi
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Olszewska-Czyz I, Kralik K, Prpic J. Biomolecules in Dental Applications: Randomized, Controlled Clinical Trial Evaluating the Influence of Hyaluronic Acid Adjunctive Therapy on Clinical Parameters of Moderate Periodontitis. Biomolecules 2021; 11:biom11101491. [PMID: 34680123 PMCID: PMC8533205 DOI: 10.3390/biom11101491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/04/2023] Open
Abstract
The biological activity of hyaluronic acid (HA) has been well-researched during the past decades; however, there are few randomized, controlled trials of its clinical effects in periodontal therapy. The purpose of this study was to evaluate the effect of hyaluronic acid on the principal parameters of periodontal healing. A specific, commercially available formulation designed and registered for professional dental application, composed of 16 mg/mL of cross-linked and 2 mg/mL of non-cross-linked HA, was used as an adjunctive to non-surgical periodontal therapy, and clinical parameters were evaluated after 3 months. The addition of HA to periodontal therapy demonstrated more favorable clinical results regarding reduction in inflammation, measured by bleeding on probing (-6% compared to the control group) and gain in periodontal attachment (1 mm more than control group), while it had no effect on probing depth reduction. No side effects were reported. Our study demonstrated that HA is a safe and easy-to-use biological agent; due to its wide array of properties, it may significantly improve the results of periodontal therapy. However, more long-term studies are needed to investigate whether these favorable effects remain over time.
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Affiliation(s)
- Iwona Olszewska-Czyz
- Department of Periodontology and Oral Pathology, Dental Institute, Medical Faculty, Jagielonian University, 31155 Krakow, Poland
- Correspondence:
| | - Kristina Kralik
- Department of Medical Statistics and Medical Informatics, Medical Faculty Osijek, University Josip Juraj Strossmayer of Osijek, 31000 Osijek, Croatia;
| | - Jelena Prpic
- Department of Oral Medicine and Periodontology, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia;
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Lobato JCRF, Dos Santos Vilhena MA, Izidoro C, Alves RC, Proença L. Single application of 0.8% hyaluronic acid as a coadjuvant of nonsurgical treatment in nonsmoking patients with periodontitis: A split-mouth, randomized, controlled pilot clinical trial. J Indian Soc Periodontol 2019; 23:545-548. [PMID: 31849400 PMCID: PMC6906898 DOI: 10.4103/jisp.jisp_674_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Topical coadjuvants might be indicated to increase the results of nonsurgical periodontal treatment and overcome some of its limitations. The aim of this study was to evaluate the clinical benefits of a single topical application of 0.8% hyaluronic acid (HA) as a coadjuvant to scaling and root planing (SRP) in periodontal patients. Materials and Methods: Sixteen patients diagnosed with periodontitis were recruited to participate in this split-mouth randomized controlled trial. At baseline, oral hygiene instructions, prophylaxis, and SRP were performed in both sides; additionally, a subgingival application of HA at 0.8% was made in the test side. Several clinical parameters were assessed at baseline, 6, and 12 weeks later: full mouth plaque score, gingival score, bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL). Results: At the end of 12 weeks, there was a overall improvement in all periodontal parameters in both sides (P < 0.05). Test sides showed less BoP when compared to the control sides (9.4 ± 4.0 vs. 14.9 ± 8.9, P < 0.05). Other periodontal parameters such as PD and CAL showed a slight improvement in comparison with the control sides, but the difference was not statistically significant (P > 0.05). Conclusion: Results from this study indicate that a single subgingival application of 0.8% HA seems to reduce gingival inflammation and improve clinical parameters, particularly BoP. Further studies are needed to evaluate the effect of repeated application of HA and long-term results.
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Affiliation(s)
| | | | | | - Ricardo Castro Alves
- Department of Periodontology, Almada, Portugal.,Egas Moniz Clinical Research Unit, Almada, Portugal
| | - Luís Proença
- Egas Moniz Clinical Research Unit, Almada, Portugal
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Eliezer M, Imber JC, Sculean A, Pandis N, Teich S. Hyaluronic acid as adjunctive to non-surgical and surgical periodontal therapy: a systematic review and meta-analysis. Clin Oral Investig 2019; 23:3423-3435. [PMID: 31338632 DOI: 10.1007/s00784-019-03012-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the potential added benefit of the topical application of hyaluronic acid (HA) on the clinical outcomes following non-surgical or surgical periodontal therapy. MATERIALS AND METHODS A systematic search was performed in Medline, Embase, Cochrane, Web of Science, Scopus and Grey literature databases. The literature search was preformed according to PRISMA guidelines. The Cochrane risk of bias tool was used in order to assess the methodology of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between the treatment and controls were estimated using the random-effect model for amount of bleeding on probing (BOP), probing depth (PD) reduction and clinical attachment level (CAL) gain. In order to minimize the bias and to perform meta-analysis, only randomized clinical studies (RCTs) were selected. RESULTS Thirteen RCTs were included: 11 on non-surgical periodontal treatment and two on surgical periodontal treatment. Overall analysis of PD reduction, CAL gain and BOP reduction in non-surgical therapy with adjunctive HA presented WMD of - 0.36 mm (95% CI - 0.54 to - 0.19 mm; p < 0.0001), 0.73 mm (95% CI 0.28 to 1.17 mm; p < 0.0001) and - 15% (95% CI - 22 to - 8%; p < 0.001) respectively, favouring the application of HA. The overall analysis on PD and CAL gain in surgical therapy with adjunctive HA presented WMD of - 0.89 mm (95% CI - 1.42 to - 0.36 mm; p < 0.0001) for PD reduction and 0.85 mm (95% CI 0.08 to 1.62 mm; p < 0.0001) for CAL gain after 6-24 months favouring the treatment with HA. However, comparison presented considerable heterogeneity between the non-surgical studies and a high risk of bias in general. CONCLUSIONS Within their limits, the present data indicate that the topical application of HA may lead to additional clinical benefits when used as an adjunctive to non-surgical and surgical periodontal therapy. However, due to the high risk of bias and heterogeneity, there is a need for further well-designed RCTs to evaluate this material in various clinical scenarios. CLINICAL RELEVANCE The adjunctive use of HA may improve the clinical outcomes when used in conjunction with non-surgical and surgical periodontal therapy.
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Affiliation(s)
- Meizi Eliezer
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland.
| | - Nikolas Pandis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Sorin Teich
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, South Carolina, USA
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10
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Tanwar J, Hungund SA. Hyaluronic acid: Hope of light to black triangles. J Int Soc Prev Community Dent 2016; 6:497-500. [PMID: 27891319 PMCID: PMC5109867 DOI: 10.4103/2231-0762.192948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/01/2016] [Indexed: 12/05/2022] Open
Abstract
Interdental papilla construction, especially in the esthetic area, is one of the most challenging tasks. Interdental papilla loss might occur due to several reasons as a consequence of periodontal surgery or trauma. The purpose of this study is to report the reconstruction of lost interdental papilla using hyaluronic acid gel. Hyaluronic acid is a glycosaminoglycan molecule with anti-inflammatory, anti-edematous properties on periodontal tissues invaded by submicrobial flora. It enhances wound healing and accelerates periodontal repair and regeneration. In addition to the field of dentistry, it has been used in other fields such as orthopedics, ophthalmology, and dermatology. It shows growth factor interaction, regulates osmotic pressure, and enhances tissue lubrication, which helps in maintaining the structural and homeostatic integrity of tissues, hence resulting in beneficial effect on lost interdental papilla. This study was aimed to reconstruct the lost interdental papilla by injecting 0.2% hyaluronic acid via nonsurgical approach. It is a noninvasive approach which reduces patient's postoperative discomfort with marked variations in the volume of interdental papilla before and after the procedure. As sufficient information is not available regarding the effectiveness of hyaluronic acid in interdental papilla construction, this study was conducted.
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Affiliation(s)
- Jyotsana Tanwar
- Department of Periodontics, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Shital A Hungund
- Department of Periodontics, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
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11
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Casale M, Moffa A, Vella P, Sabatino L, Capuano F, Salvinelli B, Lopez MA, Carinci F, Salvinelli F. Hyaluronic acid: Perspectives in dentistry. A systematic review. Int J Immunopathol Pharmacol 2016; 29:572-582. [PMID: 27280412 DOI: 10.1177/0394632016652906] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/03/2016] [Indexed: 11/16/2022] Open
Abstract
To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the soft periodontal tissue, gingiva, and periodontal ligament as well as to the hard tissue such as alveolar bone and cementum. Topical hyaluronic acid (HA) has recently been recognized as an adjuvant treatment for chronic inflammatory disease in addition to its use to improve healing after dental procedures. The aim of our work was to systematically review the published literature about potential effects of HA as an adjuvant treatment for chronic inflammatory disease, in addition to its use to improve healing after common dental procedures. Relevant published studies were found in PubMed, Google Scholar, and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 25 relevant publications were included, three of them regarding gingivitis, 13 of them relating to chronic periodontitis, seven of them relating to dental surgery, including implant and sinus lift procedures, and the remaining three articles describing oral ulcers. Not only does topical administration of HA play a pivotal key role in the postoperative care of patients undergoing dental procedures, but positive results were also generally observed in all patients with chronic inflammatory gingival and periodontal disease and in patients with oral ulcers.
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Affiliation(s)
- Manuele Casale
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - Antonio Moffa
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - Paola Vella
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - Lorenzo Sabatino
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | | | | | | | - Francesco Carinci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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