Clinical and Radiological Benefits of Hyaluronic Acid in Periodontal Infrabony Defects: A Systematic Review and Meta-analysis

Purpose: There is no consensus on the clinical and radiological benefits of hyaluronic acid (HA) in patients with periodontitis having infrabony defects. Hence, this study examined the effects of HA in periodontitis patients with infrabony defects through a comprehensive systematic review process. Methodology: A systematic literature search was performed using PubMed/Medline, Scopus, Embase and Cochrane Library from inception to March 2022. Randomized or non-randomized clinical trials and single-arm clinical trials that assessed the clinical and radiological benefits of HA in periodontitis patients with infrabony defects with a minimum of 6 months follow-up were included in this study. Surgical regenerative therapy was considered as the comparator. The Cochrane risk of bias assessment tool and Downs and Black checklist was used for the quality assessment of randomized and non-randomized interventional studies, respectively. A subgroup and sensitivity analyses were performed to explore the heterogeneity and robustness of the findings, respectively. Results: A total of 13 out of 725 studies were included in this systematic review, of which 9 were considered for meta-analysis. The meta-analysis indicated significant benefits of HA in terms of reduction in probing pocket depth (SMD: 1.12 mm; 95% CI: 0.60-1.65; 9 studies), bone defect depth (SMD: 1.04mm; 95%CI: 0.62-1.47; 3 studies) and gain in clinical attachment level (1.04 mm; 95% CI: 0.33-2.47; 8 studies). Overall, the quality of included studies was good. Conclusion: The current evidence indicates that the administration of HA in the periodontal regenerative treatment of infrabony defects was significantly effective in increasing clinical attachment levels and reducing probing pocket and bone defect depth.