Department of Periodontology, School of Dentistry, Universidad Cientifica del Sur, Calle Cantuarias 398, 15048, Miraflores, Lima, Peru.
Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, Guarulhos, SP, Brazil.
Clin Oral Investig. 2023 May;27(5):1923-1935. doi: 10.1007/s00784-022-04855-6. Epub 2023 Jan 4.
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).
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).
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.
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.
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.
本系统评价旨在评估透明质酸（HA）单独或与任何骨替代物联合用于治疗骨内缺损（IBD）的效果。
截至 2022 年 4 月，我们检索了 6 个数据库，以查找比较开放式翻瓣清创术（OFD）+HA 与 OFD 单独治疗（第一组）或 OFD+HA+骨替代物与 OFD+骨替代物治疗 IBD 的临床效果的随机临床试验（第二组），随访时间至少 3 个月。我们使用均值差的随机效应模型来确定临床附着水平（CAL）获得、探诊深度（PD）减少和放射影像学骨填充（RBF）。
在确定的 276 项研究中，有 6 项研究被纳入定性综合分析，5 项研究被纳入荟萃分析。第一组的荟萃分析显示，CAL 获得（平均差值[MD]：1.00；95%置信区间[CI]：0.65-1.35；n=2）和 PD 减少（MD：0.76；95%CI：0.34-1.17；n=2）在 6 个月时更有利于 HA+OFD，差异具有统计学意义。然而，在第二组中，荟萃分析并未显示 HA 与骨替代物联合应用在 CAL 获得（MD：0.57；95%CI：-0.30-1.43；n=2）或 PD 减少（MD：1.05；95%CI：-0.38-2.47；n=2）方面具有额外的效果，但在 12 个月时 RBF（MD：0.57；95%CI：0.15-0.99；n=2）具有显著差异。
与 OFD 单独治疗相比，HA 局部应用于 IBD 治疗在 6 个月时可显著增加 CAL 和 PD。然而，在 12 个月时，其与骨替代物联合应用的效果没有统计学意义。
与仅 OFD 相比，OFD+HA 的应用可在 6 个月的随访中改善 IBD 的 CAL 和 PD。但在 12 个月后，这些结果无法维持。
