Clinical Update quiz
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April 2026 Clinical Update
Non-Surgical Treatment of Moderate Periodontal Intrabony Defects With Adjunctive Cross-Linked Hyaluronic Acid: A Single-Blinded Randomized Controlled Clinical Trial.
Ioro-Siciliano V, Blasi A, Mauriello L, Salvi GE, Ramaglia L, Sculean A. J Clin Periodontol, 2025; 52:310–322 https://doi.org/10.1111/jcpe.14078.
Introduction
Non-surgical periodontal treatment has been shown to be an effective treatment if the probing depth (PD) ≤ 4 mm of 57% at three months and 74% at six months. Residual pockets are a risk factor for disease progression, are often associated with intrabony defects and may require surgery. Over the last few years, the treatment of the intrabony defect by minimally invasive non-surgical technique (MINST) has been proposed. The MINST approach reduces the post-operative trauma and gingival recession by using mincurettes and thin ultrasonic tips. Use of adjunctive therapies have been suggested to enhance the clinical benefits of MINST in terms of blood clot stabilisation and acceleration of healing, however the application of enamel matrix derivative (EMD) in non-surgical treatment and MINST does not improve clinical outcomes.
There have been moderate benefits of local application of hyaluronic acid (HA) on clinical outcomes of non-surgical periodontal therapy. HA stimulates blood clot formation and has a bacteriostatic effect on periodontal pathogens. It also stimulates cell proliferation and induces angiogenesis and osteogenesis. A new formulation of cross-linked hyaluronic acid gel of non-animal origin with high molecular weight (xHyA) was proposed to improve wound healing and regenerate the periodontal tissues. Histology has shown a greater area of new cementum and periodontal ligament.
It is unknown to what extent the use of xHyA in conjunction with MINST may further improve clinical outcomes in intrabony defects compared with MINST alone. The aim of this study was to clinically and radiographically evaluate the outcomes at six months following the treatment of moderate intrabony defects using MINST with or without adjunctive delivery of xHyA.
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