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Randomized Controlled Trial
. 2025 Jul 15;25(1):1166.
doi: 10.1186/s12903-025-06485-2.

Non-surgical periodontal therapy with and without hyaluronic acid gel in type 2 diabetic stage-II periodontitis patients: a randomized clinical trial

Reem Al-Abbadi  1 , Nesma Shemais  2 , Alaa Nawwar  3   4 , Karim M Fawzy El-Sayed  1   5   6
Affiliations
Randomized Controlled Trial

Non-surgical periodontal therapy with and without hyaluronic acid gel in type 2 diabetic stage-II periodontitis patients: a randomized clinical trial

Reem Al-Abbadi et al. BMC Oral Health. .

Abstract

Background: The present trial evaluated clinically and radiographically the effect of topically applied hyaluronic acid (HA) gel in conjunction with professional mechanical plaque removal (PMPR) in type 2 diabetic stage-II periodontitis patients.

Methodology: 26 controlled (HbA1c < 7%) type 2 diabetic stage-II grade B periodontitis patients were included in the current trial and randomly assigned to test (n = 13 patients; PMPR + HA) or control (n = 13; PMPR) groups. At baseline, three- and six-months clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (GRD), bleeding on probing (BOP), O'Leary plaque index (PI), HbA1c level, radiographic bone density (RBD) and defect depth (DD; all secondary outcomes) were assessed.

Results: Although CAL, PPD, BOP, PI, DD and RBD independently significantly improved in the PMPR + HA and the PMPR groups (p < 0.05), no significant differences were notable between both groups. HbA1c significantly decreased solely in the PMPR + HA group (p < 0.05).

Conclusion: Type 2 diabetic patients with stage-II periodontitis, benefit clinically from PMPR in the presence or absence of adjunctive HA gel application. Interestingly, HA as an adjunct to PMPR significantly improved HbA1c levels in controlled type 2 diabetic stage-II periodontitis patients.

Trial registration: The study was registered in the US National Institutes of Health Clinical Trials Registry (NCT05543434) in September 2022.

Keywords: Diabetes; Hyaluronic acid; Periodontics; Periodontitis; Professional mechanical plaque removal.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: The study protocols involving human participants adhered to the ethical standards set by the institutional and/or national research committee and were conducted in accordance with the principles outlined in the 2013 Helsinki Declaration and its subsequent revisions, or similar ethical standards. Both the research protocol and informed consent form were approved by the Ethics Committee of the Faculty of Dentistry, Cairo University, Egypt in June 2022 (IRB: 10|6|22). All participants included in the study gave written informed consents before their participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Clinical steps in representative case (a-g). (a) test case with 4 mm PPD with 3 mm with CAL at baseline. (b) application of topical hyaluronic acid gel using a stent in the pocket after therapy (c) Placement the stent again for 30 min one week following therapy (d) 2 mm PPD with 2 mm CAL at 2 months (e) 2 mm PPD with 2 mm CAL at 6 months. (f) control case with 5 mm PPD with 4 mm with CAL at baseline (g) SRP using Gracey curette (h) 3 mm PPD with 3 mm CAL at 3 months (i) 2 mm PPD with 2 mm CAL at 6 months
Fig. 2
Fig. 2
Digitized radiographic images (a) showing bone angle baseline measurements using ImageJ software (b) bone defects and the recorded linear measurements using ImageJ software (c) bone defect density measurement using Digora software
Fig. 3
Fig. 3
CONSORT flow diagram of participant recruitment
See this image and copyright information in PMC

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References

    1. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89(Suppl 1):S159–72. - PubMed
    1. Sadek KM, El Moshy S, Radwan IA, Rady D, Abbass MMS, El-Rashidy AA et al. Molecular basis beyond interrelated bone resorption/regeneration in periodontal diseases: A concise review. Int J Mol Sci. 2023;24(5). - PMC - PubMed
    1. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and Peri-Implant diseases and conditions. J Periodontol. 2018;89:S173–82. - PubMed
    1. Borgnakke WS, Yl€ ostalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Periodontol. 2013;84:S135–52. - PubMed
    1. Graziani F, Gennai S, Solini A, Petrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes an update of the EFP‐AAP review. J Clin Periodontol. 2018;45(2):167–87. - PubMed

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