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62 rev port estomatol med dent cir maxilofac. 2020;61(2):57-63

Side effects of systemic antimicrobial therapy and possible Ethical disclosures
poor compliance of the patient can be minimized by using
locally applied antimicrobials. Therefore, a positive influence
on the subgingival microbiota can be achieved with locally Protection of human and animal subjects. The authors
applied antimicrobials. 8 declare that no experiments were performed on humans or
Most of the studies showed a positive effect of HA applica- animals for this study.
tion together with SRP on the clinical parameters evaluat-
ed. 8-11,13 No adverse effects have been observed in its applica- Confidentiality of data. The authors declare that no patient
tion. The use of HA in the non-surgical treatment of CP relies data appear in this article.
on its potential impact on the pathological onset, as well as its
ability to improve wound healing, due to its previously demon- Right to privacy and informed consent. The authors declare
strated antimicrobial and anti-inflammatory properties, 17,18 that no patient data appear in this article.
and its pro-angiogenic 19,20 and osteoinductive potential. 18,20
HA has been demonstrated to have a bacteriostatic action
on periodontal pathogens when they are in the planktonic Conflict of interest
phase. 17,18 However, HA has a lower bacteriostatic potential
than chlorhexidine (CHX). 18,22 The authors have no conflicts of interest to declare.
All the included studies compared the outcomes between
HA gel application after SRP and the application of a placebo references
13
after SRP. Rajan et al. detected clinical improvements in the HA
group, such as a significant improvement in PPD and BOP and 1. Drisko C. Nonsurgical periodontal therapy. Periodontol 2000.
an improvement in CAL. Gontiya and Galgali showed a reduc- 2001;25:77-88.
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tion of the gingival parameters in the HA group. It also analyzed 2. Gontiya G, Galgali SR. Effect of hyaluronan on periodontitis:
A clinical and histological study. J Indian Soc Periodontol.
the inflammatory infiltrate but did not found any significant 2012.16:184-92.
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differences between the two groups. Conversely, Polepalle et 3. Sapna N, Vandana KL. Evaluation of hyaluronan gel
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al. found a significant difference in the inflammatory infiltrate (Gengigel) as a topical applicant in the treatment of
between the HA group and the placebo group. It also noticed a gingivitis. J Investig Clin Dent. 2011;2:162-70.
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significant improvement in BOP and PPD in the HA group. On 4. Nikolovska VR, Popovska M, Minovska A, Nikolovski B,
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the other hand, Xu et al. did not find improvements in peri- Kapusevska B. Influence of hyaluronic acid in periodontal
odontal health following the use of HA as a complement to SRP tissue regeneration. Romanian Journal of Oral Rehabilitation.
2013;5:3-6.
(without any clinical or microbiological upgrading). However, in 5. Parveen D, Reet K. Hyaluronic Acid: A Boon in Periodontal
this study, the HA gel was applied only once a week for 6 weeks, Therapy. North Am J Med Sci. 2013;5:309-15.
which is not enough considering the recommended application 6. Vabres P. Hyaluronan, embryogenesis and morphogenesis.
regimen of three times per day for at least 4 to 8 weeks. Ann Dermatol Venereol. 2010;137:9-14.
It is important to note that local application treatments are 7. Laurent T, Laurent C, U B, Fraser, JR. Functions of hyaluronan.
Ann Rheum Dis. 1995;54:429-32.
more effective because of their ability to provide localized high 8. Salavadhi SS, Chintalapani S, Pabolu CH, Paul A , Mutthineni
concentrations; however, they also have the disadvantage of RB, Guntu KK. Local Delivery of Hyaluronan as an Adjunct to
gingival fluid clearance. 23 Scaling and Root Planing in the Treatment of Chronic
The included studies do not provide full information on Periodontitis. J Periodontol Implant Dent. 2016;8:12-8.
participants. Also, all studies had a follow-up of 12 months, 9. Shah SA, Vijayakar HN, Rodrigues SV, Mehta CJ, Mitra DK,
which is relatively short, and, in some studies, the participants Shah RA. To compare the effect of the local delivery of
applied the products at home. Most studies of this systematic hyaluronan as an adjunct to scaling and root planing versus
review, after the risk of bias assessment, were classified as scaling and root planing alone in the treatment of chronic
periodontitis. J Indian Soc Periodontol. 2016;20:549-56.
having a high risk of bias, according to the Cochrane Collabo- 10. Polepalle T, Srinivas M, Swamy N, Aluru S, Chakrapani S,
ration guidelines. 24 Chowdary BA. 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. J
Conclusions Indian Soc Periodontol. 2015;19:37-42.
11. Xu Y, Höfling K, Fimmers R, Frentzen M, Jervøe-Storm PM.
Clinical and Microbiological Effects of Topical Subgingival
The data obtained from this systematic review suggest that Application of Hyaluronic Acid Gel Adjunctive to Scaling and
HA can play a positive role in tissue repair and wound healing. Root Planing in the Treatment of Chronic Periodontitis. J
In periodontitis, the HA + SRP combined treatment offers Periodontol. 2014;75:1114-8.
more satisfactory results than the conventional treatment of 12. Al-Shammari NM, Shafshak SM, Ali MS. Effect of 0.8%
SRP alone in most of the outcome variables presented. The Hyaluronic Acid in Conventional Treatment of Moderate to
findings suggest that the use of HA as an adjuvant should be Severe Chronic Periodontitis. J Contemp Dent Pract.
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However, studies still need to be carried out to specify the Hyaluronic Acid as an Adjunct to Scaling and Root Planing in
methods of administration and establish proper recommen- Chronic Periodontitis. A Randomized Clinical Trail. J Clin
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