Comparision of crosslinked hyaluronic acid vs. enamel matrix derivative for periodontal regeneration: an 18-month follow-up randomized clinical trial.

Abstract

Aim: To compare the effects of 1.8% hyaluronic acid (HA) and enamel matrix derivative (EMD) on periodontal regeneration in patients with periodontal bone defects, using clinical and radiographic parameters as outcome measures.

Materials and methods: We included 53 patients with 53 intrabony defects in this study who were randomly assigned to either the HA (test) or EMD (control) groups. Clinical and radiographic parameters were evaluated at 6, 12, and 18 months after the surgery.

Results: Clinical measurements at 6, 12, and 18 months after surgery demonstrated significant improvements in probing depth (PD), clinical attachment level (CAL), recession (REC), and bleeding on probing for both groups compared with baseline (p < 0.001). The EMD group exhibited the highest CAL gain of 2-3 mm at 6 months, observed in 14 of 26 (53.8%) defect sites. Conversely, the HA group demonstrated a CAL gain ≥ 4 mm at 18 months, observed in 13 of 27 (48.1%) defect sites. Radiographic assessments at 6, 12, and 18 months demonstrated significant improvements from baseline for both groups (p < 0.001).

Conclusion: We found significant clinical and radiographic benefits of HA and EMD at 18 months, with some limitations in effectiveness for specific intraosseous defects.

Clinical relevance: This study demonstrated that hyaluronic acid (HA), combined with minimally invasive techniques, enhances periodontal regeneration by improving PPD reduction, CAL gain, and radiographic bone filling, with cost-effectiveness, application, and bioavailability surpassing that of other biomaterials. Based on these results, HA can be considered a viable alternative to EMD in indicated cases.

Clinical trial registration number: clinicalTrial.gov - NCT04274244.