Comparison of Hyaluronic Acid Versus Enamel Matrix Derivative in the Treatment of Intrabony Periodontal Defects: A Systematic Review and Meta-Analysis

Abstract

Purpose Evaluate the potential non-inferiority of hyaluronic acid (HA) when compared to enamel matrix derivative (EMD) for the surgical management of intrabony defects. Methods and Materials A systematic search was performed in PubMed, ScienceDirect, Scopus, Google Scholar, LILACS, following PRISMA guidelines. Weighted mean differences (WMD) and 95% confidence intervals (CI) between HA and EMD were estimated using a random-effect model for clinical attachment level (CAL gain, primary outcome), probing pocket depth (PPD), and gingival recession (REC). A non-inferiority margin of 0.5 mm was defined for CAL. In order to minimise bias, only randomised clinical studies (RCTs) were selected. Results Across 117 articles, 3 RCTs were included. HA achieved clinical non-inferiority in CAL gain versus EMD (WMD = 0.51 mm, CI [–0.08; 1.11] at 12 months, WMD = 0.53 mm). Regarding PPD, the data do not support the non-inferiority hypothesis in comparison to EMD at 12 months (PPD: WMD = 0.71 mm, CI [–0.11; 1,54], I2=72.5%). For gingival recession, HA demonstrated clinical non-inferiority at 12 months (WMD = -0.4 mm, CI [–0.79; –0.01], I2 = 0). Conclusion Within the limits, the present data indicate that HA could be an alternative to EMD in intrabony defects. Further RCTs are required to consolidate these preliminary results. Prospero registration number: CRD420261301986