EVALUATION OF TOPICAL SUBGINGIVAL APPLICATION OF HYALURONIC ACID (HA) GEL ADJUNCTIVE TO SCALING AND ROOT PLANING (SRP) IN THE TREATMENT OF CHRONIC PERIODONTITIS.

Objective: The aim of this study is to assess effect of sub-gingival application of hyaluronic acid (HA) gel .8% adjunctive to non-mechanical debridement in treatment of chronic periodontitis based on clinical scoring and microbiological study. Subjects and Methods: The present study was carried out on 20 patients with chronic periodontitis with at least two quadrants with pocket depth ≥5 mm within the same arch. Split-mouth study design was used where control side received (SRP) only and study side received both (SRP) and subgingival application of high molecular weight 0.8% hyaluronic acid gel in a 3 months follow-up study. After clinical assessment and plaque sample collection all patients received full mouth SRP in both study and control sites at the baseline, 2nd, 4th and 6th weeks. Study sites additionally received 0.8% HMW HA gel sub-gingivally till the depth of pocket, this done once a week starting at the baseline then repeated at weeks 1, 2, 3, 4, 5 and 6 for a total seven applications. Subgingival plaque samples were collected prior to clinical measurements from both study and control sites at the baseline, 6th and 12th weeks for PCR examination. Evaluation included clinical and microbiological parameters that recorded at the base line, th 6th and then in 12th week. Clinical parameters included: Plaque index (PI), Gingival index(GI), Periodontal probing depths (PPD), Clinical attachment loss (CAL) and clinical attachment regain where, micriobiological assessment included qualitative polymerase chain reaction (PCR) for detection of both provotella intermedia and porphyromonus gingivalis in both sides . Results: In the present study, there were highly significant clinical improvements in all measured clinical parameters (Plaque index (PI), Gingival index (GI), Periodontal probing depths (PPD), Clinical attachment loss (CAL) and clinical attachment regain) in study sites which received SRP and HA more than that achieved within controls at all interval points of recording after starting the treatments: 6th and 12th weeks. In addition, PCR results showed high significant bacteriostatic effects of HA on the two periodontal pathogens under study: provotella intermedia and porphyromonus gingivalis have been found in study sites at 6th and 12th weeks more than that achieved among controls. Conclusions: Scaling and root planning (SRP) can result in the reduction of many clinical signs of the chronic periodontitis but applications of (0.8%) high molecular weight hyaluronic acid gel form (HMW HA) as an adjunctive to scaling and root planning (SRP) found to have significant clinical effects among study defects more than that achieved by (SRP) alone in controls with high power of repair attachment regain with long time prolonged action. (HMW HA) gel form has significant bacteriostatic effects on p.intermedia and p.gingivalis.