¿Cuál es el uso del ácido hialurónico en el campo Oral?

Ácido hialurónico  (HA) plays a crucial role in clinical applications, including moisture retention, lubrication, yregulation deosmotic pressure. It protects normal cells from toxic cells and free radicals, and stimulates cell migration, adhesion, proliferation, and differentiation [1]. With the advancement of research and the accumulation of clinical experience, hyaluronic acid has found many new applications, and its use in the oral field has gradually gained attention.

1 aplicación de ácido hialurónico en el trastorno de la articulación Temporomandibular

Temporomandibular joint disorder (TMJD) is one of the most common conditions in the oral and maxillofacial region, characterised by symptoms such as joint noises, pain, and abnormal movement of the mandible. Intra-articular drug Inyección de inyecciónis one of the conservative treatment methods for this condition. Sodium hyaluronate (SH) is the sodium salt form of hyaluronic acid. In recent years, several studies have reported that intra-articular injection of SH can effectively treat TMJD [2-3].

Hyaluronic acid is secreted by synovial B cells and exists in the synovial fluid and cartilage of joints in the form of sodium salts, performing functions such as lubrication, protection, and nutrition of joint structures. Li Chunjie etal. [4] conducted a systematic review of clinical randomised controlled trials evaluating SH treatment for Articulación temporomandibularstructural disorders. They found that SH significantly improved patients' Máxima apertura bucal tanto a corto como a largo plazo, y mejoró significativamente la evaluación clínica general de la enfermedad a corto plazo; Sin embargo, sus efectos a largo plazo no fueron significativos. En comparación con los glucocorticoides, la SH demostró una evaluación global clínica a corto plazo superiory menos reacciones adversas después de la inyección.

Intra-articular injection of SH into the temporomandibular joint can also effectively treat temporomandibular joint osteoarthritis (TMJOA). Liu Peicai et al. [5] found in their study on the mechanism of action of SH that SH may exert its therapeutic effect on TMJOA by reducing the levels of matrix metalloproteinases-2and 3in the synovial fluid of patients, thereby slowing down the rate of cartilage matrix destruction in the joint. Other reports [6] have also indicated that joint lavage and intra-articular injection of SH solution after condylar fracture surgery can prevent and treat postoperative complications. The mechanism of action may involve: supplementing endogenous hyaluronic acid deficiency, restoring joint surface lubrication, regulating intra-articular viscoelasticity, improving joint mobility, and feedback regulation of the patient's propia biosíntesis de ácido hialurónico para eliminar sustancias que causan dolor.

2   Aplicación de ácido hialurónico en enfermedades del tejido periodontal

2.1  Aplicación de ácido hialurónico en la gingivitis inducida por placas

Plaque-induced gingivitis is a chronic infectious disease of the gingival tissue, currently primarily treated through oral hygiene education and scaling. When used alone, hyaluronic acid gel can significantly alleviate gingival inflammation in plaque-induced gingivitis. Combining hyaluronic acid gel with scaling therapy for gingivitis is more effective and more beneficial for the recovery of gingival inflammation and improvement of clinical indicators compared to scaling alone [7]. Some researchers have evaluated the efficacy of locally applied hyaluronic acid gel for treating gingivitis from clinical and histopathological perspectives: due to its antibacterial, anti-inflammatory, and anti-edematous properties, hyaluronic acid improves gingival indices and reduces damage to tooth hard tissue and periodontal tissue caused by repeated scaling, whether used alone or as an adjunct to scaling.

2.2 aplicación de ácido hialurónico en periodontitis crónica

For the treatment of periodontitis, mechanical therapy alone can achieve good clinical outcomes for most patients. However, for a minority of patients, comprehensive treatment is required, which includes not only mechanical debridement but also adjunctive antimicrobial therapy [8]. Localised drug application, which can directly reach the affected area, has high local concentrations of antimicrobial agents, acts slowly and sustainably, and has minimal adverse effects, making it widely used in modern periodontitis treatment. Xu Yi et al. [9] found that hyaluronic acid combined with subgingival scaling and root planing (SRP) could rapidly reduce inflammatory responses in periodontal tissues of patients with chronic periodontitis, but no promotional effect on periodontal tissue repair and regeneration was observed. Other researchers [10] reported that after modified Widmann flap surgery for chronic periodontitis, local application of 0.8% hyaluronic acid gel significantly improved attachment levels and reduced gingival recession. Additionally, studies have shown that hyaluronic acid combined with guided periodontal tissue regeneration promotes alveolar bone repair and mineralisation in the treatment of chronic periodontitis. 

Hyaluronic acid is an important component of the extracellular matrix of periodontal connective tissue cells and regulates the hydration of the extracellular matrix. Ácido hialurónico de alto peso molecular can inhibit the proliferation of gingival epithelial cells, fibroblasts, and lymphocytes, shorten the inflammatory process of periodontitis, and improve the condition of the affected area. Since numerous studies both domestically and internationally have demonstrated that hyaluronic acid possesses anti-inflammatory, anti-infective, and tissue-regenerative properties, as well as promoting wound healing, local application of hyaluronic acid gel following mechanical therapy or periodontal surgery can prevent periodontal tissue destruction, reduce gingival inflammation, and facilitate periodontal tissue recovery in patients with chronic periodontitis.

2.3 aplicación de ácido hialurónico en Peri-implantitis

Peri-implant mucositis is an early stage of peri-implantitis, with inflammation confined to the gingival mucosa around the implant, sinbone resorption, and presenting clinical symptoms such as pocket formation and bleeding on probing. Zhang Li et al. [11] found that, compared with mechanical removal of plaque and calculus, the use of hyaluronic acid in patients with peri-implant mucositis resulted in a significant reduction in the peri-implant gingival sulcus bleeding index and plaque index. For peri-implantitis, due to the formation of deep peri-implant pockets and significant alveolar bone resorption, comprehensive treatment should be administered, including scaling, medication, bone grafting, membrane technology, and membrane gingivoplasty. However, whether hyaluronic acid can exert antibacterial, anti-inflammatory, and tissue regeneration and healing effects during treatment remains to be further investigated.

Algunos investigadores han realizado estudios exploratorios sobre el tratamiento de la periimplantitis utilizando métodos no quirúrgicos. Después de retirar mecánicamente la placa y realizar el raspado y cepillado de raíces (SRP), inyectaron una solución que contenía 0,2% de clorhexidina y0.8% hyaluronic acid into the pocket. Compared with pre-treatment levels, the peri-implant index improved significantly in all groups, and there were no significant differences between groups. They concluded that hyaluronic acid and chlorhexidine have similar efficacy when combined with mechanical methods for treating peri-implantitis.

3   Aplicación de ácido hialurónico en la cicatride heridas

3.1  Aplicación de ácido hialurónico en la cicatride heridas por extracción dental

La cicatride las heridas por extracción está influenciada no solo por factores sistémicos y locales como las condiciones físicas y químicas, hormonas y medicamentos, sino también por una serie de factores de crecimiento, incluyendo la osteopontina (OPN), la proteína morfogenética ósea (BMP)-2, y el factor de crecimiento endotelial vascular (VEGF).

Mendes et al. [12] injected high-molecular-weight hyaluronic acid gel into rat tooth extraction sites and analysed the histological and morphological changes during the healing process. They found that by day 7 post-extraction, the number of trabecular bones in the apical and middle thirds of the root was significantly increased; by day 21 post-extraction, in addition to an increase in the number of trabecular bones, bone matrix deposition and cell arrangement were more ordered; simultaneously, within 2–7 days post-extraction, the overall expression of OPN and BMP-2 in the extraction site was enhanced, with particularly prominent expression in the apical 1/3 region.

Researchers studying the healing process of rabbit extraction sockets found that, compared to the blank control group, the group injected with 0.8% hyaluronic acid gel into the extraction socket exhibited earlier and more abundant alveolar bone formation within the socket. Based on this, Zeng Yunting et al. [13] concluded that: Hyaluronidase in the extraction socket breaks down high-molecular-weight hyaluronic acid into low-molecular-weight hyaluronic acid, which stimulates bone formation-inducing factors to promote wound healing; simultaneously, hyaluronic acid also stimulates the migration and proliferation of endothelial cells, thereby promoting angiogenesis, increasing the number of osteoblasts from blood vessels, and enhancing bone formation.

3.2 aplicación de ácido hialurónico en la cicatride heridas de implantes

Lai Hanbiao et al. [14] conducted a randomised double-blind study on 50 patients who underwent dental implant surgery, comparing the effects of hyaluronic acid gel and saline solution on wound healing. The results showed that hyaluronic acid gel significantly promoted wound healing, particularly during the early stage of wound healing (on the 3rd day). Hyaluronic acid can significantly reduce wound redness and swelling, thereby alleviating patients' Respuestas al dolor. Esto se atribuye al papel de las sales de ácido hialurónico en la reparación de heridas, incluyendo la limpieza de heridas, efectos antiinflam, y la promoción de la cicatride heridas. Sus productos metabólicos pueden promover la vascularización y la proliferación de fibrobla, así como regular la síntesis de colágeno. Galli et al. [15] no encontraron que el ácido hialurónico promueva la cicatride heridas después de la cirugía con implantes orales, lo que puede estar relacionado con el tiempo de evaluación tardí(10 días después de la cirugía), el sistema de puntuación subjetivo y el tamaño pequeño de la muestra. En resumen, si el ácido hialurónico puede promover la cicatride heridas después de la cirugía de implantes queda por confirmar mediante estudios adicionales.

4  Aplicación de ácido hialurónico en sistemas de administración de fármacos

As a carrier, hyaluronic acid can deliver various drugs to specific pathological sites, enabling targeted drug delivery and slow release at the site of action, thereby significantly enhancing drug efficacy. In the field of dentistry, hyaluronic acid is often combined with BMP to form a composite, which is applied to the surface of implants to enhance early osseointegration and promote early stability of implants [17]; or it can be injected into the implant site after radiation therapy to slowly release BMP and exert its bone-inducing effects; additionally, hyaluronic acid can be combined with recombinant human BMP-2 and placed within the periosteum to induce osteogenesis, thereby improving the repair of bone defects. Due to its inherent fluidity and adhesive properties, hyaluronic acid not only induces bone formation but also serves as a biological coating material, making it an excellent carrier.

5 aplicación de ácido hialurónico en aftas recurrentes

Recurrent aphthous ulcers (RAU) are common lesions occurring on oral mucosa. Local treatment aims to reduce inflammation, relieve pain, prevent secondary infection, and promote ulcer healing. Nolan et al. [16] treated RAU with a 0.2% hyaluronic acid gel, applied 2–3 times daily, which immediately alleviated symptoms and promoted ulcer healing. Lee et al. [17] investigated the efficacy and safety of locally applying a 0.2% hyaluronic acid gel for RAU. Specifically, 33 patients with RAU were treated with 0.2% hyaluronic acid gel applied topically twice daily for two weeks, and their subjective and objective evaluation indicators were recorded.

The results showed that 75.8% of patients experienced improvement in pain visual analogue scale scores, 57.6% had a reduction in objective ulcer counts, 78.8% had a decrease in ulcer area, and all patients demonstrated significant improvement in inflammatory signs with no adverse reactions. Thus, topical application of 0.2% hyaluronic acid gel is safe and effective for the treatment of RAU. Hyaluronic acid may act as a barrier membrane to protect mucous membranes from oral environmental stimuli, while the improvement in inflammation is attributed to its anti-inflammatory and anti-edematous properties.

referencias

[1] Huang Sili, Guo Xueping, Yang Guilan, et al. Recientes avances en la aplicación del ácido hialurónico [J]. Food and Medicine, 2009,11(1): 50-53.

[2] Largo largo X, Chen G, Cheng AH, et  Al. Un ensayo aleatorizado con- trolled trial of  superior  and  Inferior inferior temporomandibular joint  Espacio espacio injection  Con ácido hialurónico en el tratamiento de la anterior Disco disco El desplazamiento without  Reducción [J]. J  Los demás Surg, 2009,  67(2):357-361.

[3] Escoda-Francoli J, Vzquez-Delgado E, Gay-Escoda C.Scientific evidence on the   Utilidad de la inyección de ácido hialurónico intraarticular en el manejo de temporo-mandibular Disfunción [J]. Med Oral Patol Oral Cir Bucal, 2010, 15(4):e644-e648.

[4] Li Chunjie, Zhang Yifan, Jia Yuanyuan, et al. Una revisión sistemática de un ensayo clínico controlado aleatorizado sobre el tratamiento de la disfunción de la articulación temporomandibular con hialuronato de sodio [J]. West China Journal of Stomatology, 2011, 29(5): 488-493.

[5] Liu Peicai, Wang Dong, Peng Cheng, et al. Efectos del hialuronato de sodio sobre las metaloproteinasas de la matriz 2 y 3 en el líquido sinovial de pacientes con osteoartritis de la articulación temporomandibular [J]. Chinese Journal of Stomatological Research: Electronic Edition, 2011, 5(4): 356-360.

[6] Zhao Jigang, Peng Guoguang, Liang Jingzhang, et al. Estudio clínico sobre la prevención de complicaciones postoperatorias de fractura condilar por lavado articular e inyección de hialuronato de sodio [J]. Journal of Modern Stomatology, 2011, 25(2): 105-107.

[7] Wu Yafei, Huang Jiao, Xu Yi, et al. El papel del gel de Gengigel en el tratamiento de la gingivitis inducida por placas [J]. Journal of Practical Stomatology, 2005, 21(4): 540-542.

[8] Sukumar S, Drizhal I. ácido hialurónico y periodontitis [J]. Acta Medica (Hradec Králové), 2007, 50(4): 225-228.

[9] Xu Yi, Frentzen M, Jerv → e-Storm P-M. El papel del ácido hialurónico en el tratamiento de la periodontitis crónica [J]. West China Journal of Stomatology, 2004, 22(1): 32-34.

[10] Fawzy El-Sayed KM, Dahaba MA, Aboul-Ela S, et al. Aplicación Local de gel hialuronano en conjunto con cirugía periodontal: un ensayo controlado aleatorizado [J]. Clin Oral Investig, 2012, 16(4): 1229-1236.

[11] Zhang Li, Chen Gang, Ma Lian, et al. Estudio clínico sobre el tratamiento de la mucositis periimplante con hialuronato de sodio [J]. Chinese Journal of Oral Implantology, 2005, 10(1): 22-24.

[12] Mendes RM, Silva GA, Lima MF, et al. El hialuronato de sodio acelera el proceso de curación en los alvéolos dentales de las ratas [J]. Archivos de biología Oral, 2008, 53(12): 1155-1162.

[13] Zeng Yunting, Tang Guohua. El efecto de los fármacos en la cicatride los alvéolos de extracción [J]. Materiales e instrumentos orales, 2010, 19(2): 104-107.

[14] Lai, H. B., & Liu, Y. el papel del gel de ácido hialurónico en la cicatride heridas después de una cirugía de implante [J]. Guangdong Journal of Stomatology, 2008, 16 (Supplement): 637-638.

[15] Galli F, Zuffetti F, Capelli M, et al. Ácido hialurónico para mejorar la cicatride incisiones quirúren la cavidad oral: un ensayo clínico aleatoricontrolado con placebo multicpiloto [J]. Eur J Oral Implantol, 2008, 1(3): 199-206.

[16] Nolan A, Baillie C, Badminton J, et al. La eficacia del ácido hialurónico tópico en el manejo de la ulceraftosa recurrente [J]. J Oral Pathol Med, 2006, 35(8): 461-465.

[17] Lee JH, Jung JY, Bang D. La eficacia del gel de ácido hialurónico tópico al 0,2% sobre las úlceras orales recidivantes: comparación entre las aftas recidivantes y las úlceras orales de Behcet's enfermedad [J]. J Eur Acad Dermatol Venereol, 2008, 22(5): 590-595.