Improving periodontal regeneration outcomes with hyaluronic acid: A systematic review and meta-analysis

To evaluate the clinical and radiographic efficacy of the adjunctive use of hyaluronic acid (HA) in regenerative periodontal surgery for the treatment of intrabony defects.

A systematic search identified randomized controlled trials (RCTs) involving adult patients with intrabony defects who underwent regenerative periodontal surgery with adjunctive HA. The primary outcome was probing pocket depth (PPD) reduction; secondary outcomes included clinical attachment level (CAL) gain, gingival recession (REC), and radiographic defect depth (RDD) reduction. Meta-analysis according to the regenerative protocol was performed using random-effects models, with subgroup analyses.

Fourteen RCTs met the inclusion criteria. Compared to controls, adjunctive HA resulted in an additional PPD reduction of approximately 0.7-1.2 mm and CAL gain of 0.7-1.1 mm, with more consistent effects at 12 months. Subgroup analyses indicated significant benefits when HA was applied alone or with membranes, whereas no added benefit was observed with bone substitute materials. Radiographic outcomes showed a favorable trend for HA, with an additional RDD reduction of about 0.7-1.0 mm, though heterogeneity was noted. Comparisons between HA and enamel matrix derivative (EMD) revealed comparable or slightly superior results for EMD.

Adjunctive HA may enhance clinical and radiographic outcomes in intrabony defects when used in regenerative periodontal surgery, although heterogeneity and study quality warrant cautious interpretation of the findings.