Evaluation of Hyaluronic Acid and Chlorhexidine Gel as an Adjunct to Minimally Invasive Non-surgical Therapy in the Treatment of Stage III and IV Periodontitis: A Randomized Clinical Trial

A tendency to perform increasingly less traumatic procedures (like MINST) that preserve hard and soft periodontal tissues is being observed in periodontology, significantly improving the visualization and root decontamination, reducing inflammation and probing depth, and at the same time preserving the gingival margin and consequently improving the aesthetic results (Ribeiro et al., 2023).

In the literature, extracellular matrix components and various local agents have been explored as adjuncts to periodontal treatment. The unique physiochemical properties of hyaluronic acid (HA) have led to its frequent use in medical applications for many years (Dahiya & Kamal, 2013). HA, a natural extracellular matrix constituent, plays a crucial role in periodontal health (Jiang et al., 2011). It has anti-inflammatory, anti-edematous, and antibacterial properties particularly in relation to periodontal diseases arising from the interplay between the host and microbial dental biofilm (Jentsch et al., 2003). Studies suggest that HA enhances the viability of periodontal ligament (PDL) cells, preserves osteogenic differentiation, strongly promotes the proliferation of osteoprogenitor cells, and potentially aiding in regeneration of periodontal bone defects (Asparuhova et al., 2020).

CHX is the most potent chemical plaque control agent that has various clinical applications in periodontics. Its broad antimicrobial spectrum can be considered as boon for maintaining overall oral health (Thangavelu et al., 2020). Moreover, CHX has proven to be an extremely useful antimicrobial in the field of health. Locally administered and sustained CHX in the form of CHX chips is the most advantageous for long-term use as an adjunct to oral hygiene in patients with periodontitis (stage I-III) (Poppolo Deus & Ouanounou, 2022).

The control group will receive MINST only for the treatment of deep periodontal pockets. The application of MINST minimizes soft and hard tissue trauma achieving better treatment outcomes in comparison with traditional scaling and root planing. Gingival architecture is maintained, and stability of the area is preserved favoring better clot formation and stabilization (Anoixiadou et al., 2023).

Inclusion criteria

• 1. Age 25-70 2. Diagnosis of 'periodontitis' stage III or IV (grades A to C) 3. Presence of ≥ 1 'intrabony defect' (PPD, > 5 mm with intrabony defect depth ≥ 3 mm at screening radiograph) 4. Signed informed consent

Exclusion criteria

• 1. Smoking (current or in past 5 years) 2. Medical history including diabetes or hepatic or renal disease or other serious medical conditions or transmittable diseases 3. History of conditions requiring prophylactic antibiotic coverage prior to invasive dental procedures 4. Anti-inflammatory or anticoagulant therapy during the month preceding the baseline exam 5. Systemic antibiotic therapy during the 3 months preceding the baseline exam 6. History of alcohol or drug abuse 7. Self-reported pregnancy or lactation 8. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that according to the investigator may increase the risk associated with trial participation 9. Periodontal treatment to the study site within the last 12 months