Assesment of Changes ın Clinical and Radiographic Parameters Following the Application of Local Hyaluronic acıd Gel as an Adjunct to Minimally Invasive Non-surgical Treatment of Intraosseous Defects

This study was designed as a randomised controlled clinical trial and conducted between March 2022 and May 2023 at the Department of Periodontology, Bezmialem Vakıf University. Ethical approval was obtained from Clinical Research Ethics Committee of Bezmialem Vakıf University with approval number E.54753 on March 15, 2022.

The patients included in our study were selected from a total of 140 patients with complaints of gingival problems who applied to the Department of Periodontology at Bezmialem Vakıf University Faculty of Dentistry, specifically those having intraosseous defects in the premolar/molar teeth. Forty-two individuals were included in the study, and it was completed with a total of 36 participants, consisting of 25 females and 11 males.

Initial clinical periodontal measurements and periapical radiographs were taken from the defect area with parallel technique in the first session. Occlusal stents with fixed guide points were prepared to place the periodontal probe with the correct angle and inclination. During the initial session, complete oral supragingival calculus cleaning and oral hygiene motivation were performed. After that, patients were randomly assigned to the test (MINST + HA, n = 17) or control (MINST, n = 19) groups. Neither the patients nor the expert responsible for the clinical measurements (UGE) was aware of which treatment each individual had received.

The MINST concepts described by Nibali et al. were followed in the treatment protocol. During the procedure, a subpapillary approach was taken to reduce trauma to the soft tissues, particularly the papillae, using a 2.5x420 mm magnification loop . The instruments were gently placed within the periodontal pocket while the patient was under local anaesthesia , in order to keep the soft tissues stable. Using mini five curettes and ultrasonic devices with precise tips ,the root surfaces were cleaned reaching to the base of the pocket, avoiding excessive root surface smoothing and gingival curettage. The subgingival area was not irrigated to prevent deterioration of clot stabilisation during the wound healing process [1]. MINST was performed in all areas of the oral cavity with periodontal pockets >3 mm. The control group was treated with MINST alone without using any irrigation solution. Beside, in the test group, following MINST protocol same as in the control, HA gel was applied to the periodontal pockets where the intraosseous defect was located using a sterile injector with a plastic needle. The gel was applied until it overflowed from the gingival sulcus. Patients were instructed not to eat, drink or brush their teeth for at least one hour. Subgingival application of HA was repeated 4 weeks after the first session. The control group received placebo HA gel probe without rinsing.

Clinical examination Initial clinical measurements were taken by a single investigator (UGE) using the UNC15 probe at six sites on all teeth to determine the stage and grade of periodontitis in study population.