Efficacy Of Hyaluronic Acid As An Adjunct To Non -Surgical Periodontal Therapy In Chronic Periodontitis-A Systematic Review And Meta-Analysis

Aim: To compare and evaluate the effectiveness of hyaluronic acid (HA) as an alternative adjunct to non-surgical periodontal therapy (NSPT) in adults with chronic periodontitis (CP).Methods: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD CRD42023470147.Electronic databases were searched from January 2000 to November 2023 for studies evaluating the effectiveness of HA in adults with chronic periodontitis and reporting outcome in terms of reduction in probing depth (PD), plaque index (PI), gingival index (GI), bleeding on probing (BOP) and gain in clinical attachment level (CAL).Quality assessment was evaluated using Cochrane risk of bias (ROB) -2 tool for randomized controlled trials (RCT) through its domains using review manager (RevMan) software version 5.3 and newcastle Ottawa scale (NOS) was used for retrospective study.The standardized mean difference (SMD) was used as summary statistic measure with random effect model (p<0.05).Results: Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis and for meta-analysis.Quality assessment revealed a moderate to low risk of bias.It was observed that pooled estimate through SMD favoured HA group compared to NSPT group, as an overall SMD of -1.42 (-2.20 -0.65), -0.73 (-1.35 -0.11), -0.79 (-1.26 -0.33), 0.31 (-0.26 -0.88), -4.51 (-11.45 -2.43) was seen for decrease in PI, GI, PD, gain in attachment level and decrease in BI suggesting that HA is superior to NSPT in treatment of chronic periodontitis.Funnel plot did not reveal the presence of any heterogeneity indicating absence of publication bias.Conclusion: It was found that the sub-gingival application of HA resulted in better, significant and beneficial improvement in periodontal parameters.It was concluded that HA can be used alone or in-conjugation with NSPT/SRP for improving the periodontal health.