Clinical Efficacy and Patient Experience of Adjunctive Hyaluronic Acid-based Gel Application With Coronally Advanced Flap in Type 1 Gingival Recession: A Randomized Controlled Clinical Trial

Objective Hyaluronic acid (HA) has been suggested as a local chemotherapeutic agent in periodontal treatments due to its role in wound healing and periodontal regeneration. The aim of this study is to evaluate the effect of HA use in addition to the coronally advanced flap (CAF) technique in type 1 gingival recession (RT1) on postoperative morbidity, clinical parameters, and patient satisfaction, analyzed at baseline and 6 months. Materials and Methods This split-mouth study included 20 patients (9 males, 11 females) with a mean age of 42.10 ± 9.46 years who were diagnosed with bilateral RT1 gingival recession in the maxilla. The right and left defect areas of the 20 patients were randomly assigned to two groups. The control group received CAF (n = 20), and the test group received CAF + HA (n = 20). Pre-treatment plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), vertical recession depth (VRD), horizontal recession width (HRW), gingival thickness (GT), attached gingival width (AGW), and keratinized gingival width (KGW) were recorded. Additionally, a satisfaction analysis was conducted, including patient-based comfort (PCS), aesthetic (PAS), and sensitivity (PSS) scores. During the operation, a 0.8% HA gel was applied to the defect areas in the test group, in addition to CAF, while saline was applied to the control group, also in addition to CAF. Pain, bleeding, and edema scores, as well as the number of painkillers, were recorded during the 9-day postoperative period. Clinical parameter measurements and patient satisfaction analyses were repeated 6 months after surgical treatment. Results When intra-group comparisons were evaluated, statistically significant improvements were found in clinical parameters, including PPD, CAL, VRD, HRW, GT, AG, and KGW, and patient satisfaction analysis at 6 months compared to baseline in both groups ( P  < 0.05). Also, while there was no significant difference in GI in the test group ( P  > 0.05), the control group showed an increase at 6 months compared to baseline ( P  < 0.05). In the intergroup comparison, a significantly greater increase in PBC was observed in the test group compared to the control group at 6 months ( P  < 0.01), whereas no significant differences were detected in other clinical parameters or patient satisfaction analysis scores ( P  > 0.05). Results Our study suggests that addictive HA to CAF may improve GI and PCS, thereby increase treatment effectiveness and facilitating patient tolerance. Clinical relevance: The application of 0.8% HA gel in combination with CAF provides positive results in GI and PCS in patients with RT1 gingival recession compared to CAF alone.