Evaluation of Hyaluronic Acid and Chlorhexidine Gel as an Adjunct to Minimally Invasive Non-surgical Therapy in the Treatment of Stage III and IV Periodontitis

Overview

Stage III and IV periodontitis are advanced forms of periodontal disease characterized by significant attachment loss, deep periodontal pockets, and progressive destruction of supporting periodontal tissues. Minimally invasive non-surgical therapy (MINST) has been proposed as an effective treatment approach aimed at minimizing tissue trauma while achieving optimal biofilm and calculus removal. Adjunctive therapies may further enhance clinical outcomes by promoting wound healing and reducing inflammation. This randomized clinical trial aims to evaluate the effectiveness of a hyaluronic acid and chlorhexidine gel (Periofix Plus Gel) used as an adjunct to MINST in patients with Stage III and IV periodontitis. Participants will be randomly assigned to receive either MINST alone or MINST combined with local application of the hyaluronic acid/chlorhexidine gel. Clinical periodontal parameters, including probing pocket depth, clinical attachment level, bleeding on probing, and plaque-related indices, will be assessed at baseline and follow-up visits to determine whether adjunctive gel application provides additional clinical benefits compared with MINST alone. The study hypothesis is that the adjunctive use of hyaluronic acid and chlorhexidine gel following MINST will result in greater periodontal pocket reduction, improved clinical attachment gain, and enhanced soft tissue healing compared with MINST alone.

A tendency to perform increasingly less traumatic procedures (like MINST) that preserve hard and soft periodontal tissues is being observed in periodontology, significantly improving the visualization and root decontamination, reducing inflammation and probing depth, and at the same time preserving the gingival margin and consequently improving the aesthetic results. In the literature, extracellular matrix components and various local agents have been explored as adjuncts to periodontal treatment. The unique physiochemical properties of hyaluronic acid (HA) have led to its frequent use in medical applications for many years. HA, a natural extracellular matrix constituent, plays a crucial role in periodontal health. It has anti-inflammatory, anti-edematous, and antibacterial properties particularly in relation to periodontal diseases arising from the interplay between the host and microbial dental biofilm. Studies suggest that HA enhances the viability of periodontal ligament (PDL) cells, preserves osteogenic differentiation, strongly promotes the proliferation of osteoprogenitor cells, and potentially aiding in regeneration of periodontal bone defects. CHX is the most potent chemical plaque control agent that has various clinical applications in periodontics. Its broad antimicrobial spectrum can be considered as boon for maintaining overall oral health. Moreover, CHX has proven to be an extremely useful antimicrobial in the field of health. Locally administered and sustained CHX in the form of CHX chips is the most advantageous for long-term use as an adjunct to oral hygiene in patients with periodontitis (stage I-III). The control group will receive MINST only for the treatment of deep periodontal pockets. The application of MINST minimizes soft and hard tissue trauma achieving better treatment outcomes in comparison with traditional scaling and root planing. Gingival architecture is maintained, and stability of the area is preserved favoring better clot formation and stabilization.