Modulation of gingival inflammation and clinical outcomes in periodontitis by sodium hyaluronate and ultrasonic debridement: a clinical study

Periodontitis is a chronic inflammatory disease leading to progressive destruction of tooth-supporting tissues. Conventional therapy with ultrasonic debridement (UD) reduces microbial load and inflammation with limited anti-microbial effects. Sodium hyaluronate (SH), with its anti-inflammatory and wound-healing properties, has a promising role in enhancing clinical outcomes. This study aims to evaluate the effect of using SH as an additional therapy with debridement in chronic periodontitis. A clinical comparative study was conducted on 258 patients with chronic periodontitis, divided into three groups: SH gel alone ( n = 80), UD alone ( n = 90), and combined SH + UD therapy ( n = 88). We evaluated clinical parameters, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) along with gingival crevicular fluid (GCF) biomarkers (IL-1β, IL-6, TNF-α) and systemic markers (CRP, ALP) at baseline, 4 weeks, and 8 weeks. Among 258 participants, the three groups were largely comparable at baseline. Across 8 weeks, all outcomes improved with significant Time-Group interactions. The Combined regimen yielded the greatest reductions in IL-1β, IL-6, and in clinical indices (PI, GI, BOP); clinical attachment loss improved similarly with Combined and UD and more than SH. ALP changes significantly appeared only at 8 weeks especially with combined group. Serum CRP decreased in all groups but remained highest in UD and lowest in SH at both follow-ups. Adjunctive use of SH with UD enhances periodontal therapy by reducing pro-inflammatory cytokines, improving systemic markers, and promoting clinical healing. Incorporating SH into non-surgical treatment protocols may optimize periodontal stability. https://doi.org/10.17605/OSF.IO/ACRQP , registered on 2 December 2025.