Applications of Hyaluronic Acid in Soft Tissue Management: A Narrative Review of Recent Insights from Contemporary Periodontology

Abstract

Hyaluronic acid (HyA) is a naturally occurring glycosaminoglycan with notable anti-inflammatory, antimicrobial, and regenerative effects. In periodontology, its applications have extended across a spectrum of soft tissue-related procedures, including post-extraction socket healing, interdental papilla reconstruction, root coverage, keratinized gingiva (KG) augmentation, and periodontal therapy. Despite its growing application in clinical practice, the use of HyA in periodontal soft tissue management lacks standardized protocols and long-term clinical validation. This review aims to synthesize recent evidence and address this gap by categorizing current applications and evaluating their specific outcomes. A narrative review was conducted by searching PubMed (Medline) for relevant studies published between January 1, 2014, and February 28, 2025. The search followed the PCC framework and was complemented by manual exploration through Google Scholar. The PRISMA statement 2020 was followed to select the included studies. A total of 104 records were identified through electronic and manual searches. After removing one duplicate, 103 records were screened. Following title and abstract screening, 22 articles were assessed for full-text eligibility. Of these, one article could not be retrieved, and two were excluded, resulting in 19 studies being included in the final review. Included studies were thematically categorized into five clinical applications: post-extraction healing, interdental papilla regeneration, root coverage procedures, keratinized gingiva augmentation, and periodontal therapy. Across these contexts, HyA demonstrated varying degrees of clinical benefit, particularly in enhancing early healing and esthetic outcomes. HyA represents a biologically active adjunct in periodontal soft tissue management, with context-specific benefits. Standardization of protocols and long-term trials is necessary to define their optimal clinical use.