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The aim of this study was to clinically, immunologically and microbiologically evaluate the potential additional effects of amino-acid sodium hypochlorite (AA-NaOCl) and cross-linked hyaluronic acid (xHA) to SRI at 3 and 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>At the time point of reevaluation during systematic periodontal therapy, eligible patients were allocated to either control group receiving SRI of residual pockets, or test group with the adjunctive AA-NaOCl and xHA. Per patient 2 study sites were selected and clinical periodontal parameters (PD, CAL, BOP, and pocket closure), immunological biomarkers and 8 major periopathobionts were analyzed at baseline, after 3 and 6 months. Detection of IL-1\u03b2 and MMP-8 was carried out using ELISA, the abundance of the periopathobionts by qPCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Improvements in the clinical parameters were demonstrated in all 42 included patients. In the test group an additional PD reduction by 0.50\u00a0mm (1.38, 95% CI range: 1.11\u20131.65 vs. 0.88, 95% CI range: 0.62\u20131.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008) and CAL gain by 0.57\u00a0mm (1.07, 95% CI range: 0.70\u20131.44 vs. 0.50, 95% CI range: 0.24\u20130.76;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017) was found compared to the control group. The percentage of residual pockets decreased by 88.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200937) in the test, and 38.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916) in the control group. There was no significant change in the immunological parameters. The abundance of 5 periopathobionts significantly decreased in the test group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The adjunctive application of AA-NaOCl and xHA significantly improved the clinical and microbiological outcome 3 and 6 months after SRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This trial was registered in the German Clinical Trials Register (ID: DRKS00017415 at 03\/06\/2019).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-08694-9","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T03:04:36Z","timestamp":1780110276000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of sodium hypochlorite and hyaluronic acid in subgingival re-instrumentation \u2013 a randomized clinical trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Gert","family":"Jungbauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Stalder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Sculean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrun","family":"Eick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Jentsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"issue":"Suppl 20","key":"8694_CR1","first-page":"S130","volume":"45","author":"M Billings","year":"2018","unstructured":"Billings M, Holtfreter B, Papapanou PN, Mitnik GL, Kocher T, Dye BA. 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