Application of High-concentration 35 kDa Hyaluronic Acid Fragment Gel in the Treatment of Mild Gingival Recession and Periodontal Inflammation: A Case Series

Abstract

Background: Periodontal disease is a chronic inflammatory condition characterized by gingival redness and bleeding in its early stages, which can progress to gingival recession and tooth mobility in severe cases. Increasing evidence suggests that periodontal disease represents a systemic chronic inflammatory disorder often associated with cardiovascular diseases. Therefore, its effective management is crucial for overall health. Hyaluronic acid (HA), an essential component of gingival connective tissue, possesses anti-inflammatory and tissue-repairing properties. Low-molecular-weight HA fragment has been proven effective in reducing inflammation in skin and mucosal applications; however, their role in gingival repair remains unclear. Methods: This case series included four male patients with mild gingival recession (Miller Class I or II) and chronic gingival or radicular pain associated with periodontal disease. All participants applied a 10% high-concentration 35 kDa HA fragment gel twice daily—to the teeth and gingiva—over a 42-day treatment period. Gingival growth was measured visually by comparing root exposure length before and after treatment. Standardized pain and discomfort scales were used to assess changes in gingival pain, redness, swelling, itching, and bleeding induced by tooth brushing. Results: After 42 days of treatment, the average gingival regrowth was 1.2 mm, with the exposed dark root surface decreasing from 1.4 ± 0.2 mm to 0.2 ± 0.1 mm. The average chronic gingival or radicular pain score dropped from 2.4 to 0. Gingival itching and discomfort disappeared within 30 seconds of application, redness and swelling improved markedly within 4 days, and brushing-induced bleeding stopped within 2 days. All patients demonstrated excellent compliance, and no adverse reactions were observed. Conclusion: Topical application of a 10% HA35 gel was associated with improvement in mild gingival recession and periodontal inflammatory symptoms in this small case series. This formulation shows promising potential for periodontal-related gingival repair and home oral care, warranting further clinical investigation.