Prof Andrea Pilloni: Interview about cross-linked Hyaluronic Acid

Prof Andrea Pilloni: Pioneer in Periodontal Regeneration with Hyaluronic Acid

Prof Andrea Pilloni is the head of the Section of Periodontology at the University of Rome, Sapienza. Prof Andrea Pilloni serves the Italian Society of Periodontology as active member and member of the Scientific Committee. Active Member of the Wound Healing Society and of the Italian Academy of Esthetic Dentistry. Involved in basic and clinical research on the use of hyaluronan (aka hyaluronic acid) since 1989. Author of articles in peer-reviewed journals and of one book on GTR. Private practice is limited to Periodontics in Rome, Italy. He is Board Certified in Periodontology by the Italian Society of Periodontology.

Prof Pilloni is seen as the authority when it comes to periodontal regeneration with regard to using hyaluronic acid with some of his research started already in the early 90’s. Prof Pilloni is involved in several international initiatives aiming to establish this material as a predictable option to enhance the periodontal regeneration.

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Prof Andrea Pilloni: Interview about Hyaluronic Acid for Dental Indications

Question 1: What are the clinical advantages of using cross-linked hyaluronic acid (hyadent BG) in periodontal treatment? 

Prof Andrea Pilloni : “During last year’s EuroPerio Symposium in Copenhagen, we explained with the help of great experts why cross-linked HA is matching the best clinical expectations. Reason number one: it speeds up the closure of the wounds because cells are communicating with each other and immediately closing the area. HA enables cell signalling, which is the backbone of all regenerating processess.

Also, HA has a lot to do with the blood clot and especially with its stabilization. In the hands of clinicians doing non-surgically and surgical periodontal treatment, as well as surgery around implants, we know how crucial it is to keep the blood stable. The stability of the clot helped by HA has decades of research. Now, we are able to explain to our colleagues how it works, what are the advantages and limitations of HA in periodontal regenerative therapy compared with conventional treatments.”

Question 2: You studied and used different forms of hyaluronic acid. What are in your perspective the differences between cross-linked and native/linear hyaluronic acid in the field of periodontal surgical and non-surgical therapies?

Prof Andrea Pilloni : “In 1989, while at UCLA for my Master research project, I first started investigating the role of different molecular weights of HA on osteogenesis and found a 7 fold increase in bone formation . The possible clinical use stems from our 1999 study demonstrating a bacteriostatic effect of HA. In years, until 2003, we could demonstrate very clearly that HA has a role not only in PDL cell growth but also in the initiation of its calcification towards a cementum-like tissue.

It was only in 2012 when I had the chance to meet Dr. Klaus Loesche from Bioscience who decided to have me pioneering the first clinical cases of Hyadent, at that time the only form of HA for dental use in the world. The reason for the immediate evidence of the clinical success of Hyadent relies upon his cross-linking. With that, the molecule acts to immediate stabilize the clot, which is the first biological step into tissue regeneration. In time, HA offers partial degradation products capable of eliciting important and crucial regenerative mechanisms such as angiogenic end products responsible of fast healing of soft tissue wounds.”

Question 3: What are from your perspective the main motivation to adopt an innovative therapeutical approach that favours a regenerative protocol compared to a traditional therapy without any biologics? 

Prof Andrea Pilloni : “Tissue regeneration implies several cellular mechanisms that simply should enable cells to first talk to each other (cell signalling), migrate and, at the same time, differentiate to re-populate a specific area. The major component of such peculiar environment is the presence of a unique stage of blood, namely the clot. HA has been proven, in many decades of researches and by top peer-reviewed journals, to be part of cellular cross-talk, migration, differentiation within a stable clot. Its application in clinical use would just replicate and enhance its role.”

Question 4: For what type of indications and treatments to you use cross-linked hyaluronic acid?

Prof Andrea Pilloni : “From what just said, in all cases where fast cell movement and clot stability are needed, namely in soft tissue’s wound healing and in bone regeneration and with the growing evidence by best experts all over the world in clinical application HA will be more and more the “most biologic” clinical choice.”

 

EuroPerio 10: Evidence on the different clinical applications of cross-link hyaluronic acid (Hyaluronic Acid vs Emdogain)

The management of soft tissues in periodontal and implant therapy requires in-depth knowledge of the potential of tissues in both reparative and regenerative sense.

Periodontal surgery includes surgical interventions aimed at correcting anatomical deformations of the gingiva or alveolar mucosa. Gingival recession, for example, is used to be described as the displacement of the gingival margin from its normal position on the crown of the tooth in an apical direction. The use of biologics led to better quality of soft tissue healing primarily during the very initial stages of the wound healing processes, with patient’s reduced post-op discomfort. Hyaluronic Acid (HA), by interacting with the clot and with the behaviour of cells within the wound area, seems to show molecular properties useful for the surgical treatment of mucogingival lesions.

Even the intraosseous defect requires more and more attention, especially in cases of severe attachment loss in the aesthetic areas, based on predictable surgical techniques in many cases facilitated in their regenerative path using tissue biomodulators and which make use of the great potential of healing of the tissues themselves. The presentation aims at helping clinicians in understanding the indications and in the choice of treatment modalities when in presence of intrabony defects with the aid of hyaluronic acid, a fundamental element in the biology of oral tissues.

 

Andrea Pilloni: Current state on biologics EMD, HA, PRF used in dental surgery

Hard and soft oral tissue regeneration implies the careful orchestration of scaffolds, cells, and signaling agents. The term “biologics” is often used to refer broadly to biological signaling agents such as Enamel Derived Matrix (EMD), Hyaluronic Acid (HA) and Platelet Rich Fibrin (PRF).

These biologics present a wide range of properties relevant for wound healing and regeneration following periodontal and/or oral surgery. Scientific and clinical data have recently provided substantial evidence for using EMD, cross-linked hyaluronic acid (xHyA) and PRF in conjunction with periodontal and oral regenerative surgery.

The purpose of this round table is to provide a critical update on the preclinical and clinical evidence for EMD, HA and PRF in various scenarios including treatment of gingival recessions, intrabony and furcation defects. Three world-renowned experts will summarize the available pre-clinical and clinical evidence and draw conclusions on the clinical relevance of these concepts for hard and soft oral tissue regeneration.