Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis

Bertha Inés Ostos-Aguilar, Camila Pinheiro Furquim, Francisco Wilker Mustafa Gomes Muniz, Marcelo Faveri, Jonathan Meza-Mauricio

Research output: Contribution to journalArticlepeer-review


Objective: This systematic review aimed to evaluate the effects of hyaluronic acid (HA) alone or in combination with any bone substitute for the treatment of intrabony defects (IBDs). Material and methods: Six databases were searched up to April 2022 to find randomized clinical trials comparing the clinical effects of open flap debridement (OFD) + HA versus OFD alone (first group) or OFD + HA + bone substitutes versus OFD + bone substitutes (second group) in the treatment of IBDs with a follow-up of at least 3 months. Random effects models of mean differences were used to determine the clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill (RBF). Results: Of the 276 studies identified, 6 were included in the qualitative synthesis, and 5 in the meta-analyses. The meta-analyses in the first group showed a statistically significant differences for CAL gain (mean difference [MD]:1.00; 95% confidence interval [CI]:0.65 − 1.35; n = 2) and PD reduction (MD: 0.76; 95%CI: 0.34 − 1.17; n = 2) favoring HA + OFD at 6 months. However, in the second group, the meta-analyses did no show additional effect of HA in association with bone substitute was demonstrated for either CAL gain (MD: 0.57; 95%CI: − 0.30 − 1.43; n = 2) or PD reduction (MD: 1.05; 95%CI: − 0.38 − 2.47; n = 2) but did show significant differences for RBF (MD: 0.57; 95%CI: 0.15 − 0.99; n = 2) at 12 months. Conclusion: Compared with OFD alone, local application of HA in the treatment of IBDs provided a significant CAL gain and PD reduction at 6 months. However, its combination with bone substitutes showed no statistically significant differences at 12 months. Clinical relevance: The use of OFD + HA improves the CAL and PD in the treatment of IBDs compared to OFD only after 6 months of follow-up. These results are not maintained after 12 months.

Original languageEnglish
Pages (from-to)1923-1935
Number of pages13
JournalClinical Oral Investigations
Issue number5
StateAccepted/In press - 2023
Externally publishedYes


  • Hyaluronic acid
  • Periodontal bone loss and intrabony periodontal defect
  • Periodontal regeneration


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