Comparison of Hyaluronic Acid Versus Enamel Matrix Derivative in the Treatment of Intrabony Periodontal Defects: A Systematic Review and Meta-Analysis.

PURPOSE: Evaluate the potential non-inferiority of hyaluronic acid (HA) when compared to enamel matrix derivative (EMD) for the surgical management of intrabony defects. METHODS AND MATERIALS: A systematic search was performed in PubMed, ScienceDirect, Scopus, Google Scholar, LILACS, following PRISMA guidelines. Weighted mean differences (WMD) and 95% confidence intervals (CI) between HA and EMD were estimated using a random-effect model for clinical attachment level (CAL gain, primary outcome), probing pocket depth (PPD), and gingival recession (REC). A non-inferiority margin of 0.5 mm was defined for CAL. In order to minimise bias, only randomised clinical studies (RCTs) were selected. RESULTS: Across 117 articles, 3 RCTs were included. HA achieved clinical non-inferiority in CAL gain versus EMD (WMD = 0.51 mm, CI [-0.08; 1.11] at 12 months, WMD = 0.53 mm). Regarding PPD, the data do not support the non-inferiority hypothesis in comparison to EMD at 12 months (PPD: WMD = 0.71 mm, CI [-0.11; 1,54], I2=72.5%). For gingival recession, HA demonstrated clinical non-inferiority at 12 months (WMD = -0.4 mm, CI [-0.79; -0.01], I2 = 0). CONCLUSION: Within the limits, the present data indicate that HA could be an alternative to EMD in intrabony defects. Further RCTs are required to consolidate these preliminary results. Prospero registration number: CRD420261301986.