The management of periodontal defects has been an ongoing challenge in clinical periodontics. This is mainly a result of the fact that tissues which comprise the periodontium, the periodontal ligament, and the cementum and alveolar bone, represent three unique tissues in their own right. Thus, reconstruction of the periodontium is not just a simple matter of regenerating one tissue but involves at least three quite diverse and unique tissues. Resective surgical therapy, with or without osseous recontouring, was considered the norm during the 1950s and the 1960s, in the belief that attainment of shallow pocket depths was a worthwhile goal. More recently, attention has been focused more on regenerative and reconstructive therapies, rather than on respective therapies. Among the many mediators used in periodontal regeneration is hyaluronic acid. In the field of dentistry, hyaluronic acid has shown anti-inflammatory and anti-bacterial effects in the treatment of periodontal diseases. The article reviews recent evidence of the effects of hyaluronic acid on periodontal deffects.