Tissue Regenerator

Why use hyaluronic acid in dental surgery?

The gel of cross-linked hyaluronic acid (xHyA) is used for soft tissue recession surgery, guided tissue regeneration (GTR) as well as guided bone regeneration (GBR). The pharmaceutical-grade cross-linked hyaluronic acid, based gel of non-animal origin is optimized for regenerative peri-implant and periodontal applications.

• Accelerated tissue healing – Coordinates the post-operative inflammation process and accelerates neoangiogenesis. [1,2]
• Improved outcome – Stabilizes coagulum and supports tissue regeneration. [1-4]
• Improved predictability – Bacteriostatic action and reduced pathogen penetration. [5]

Six reasons to use cross-linked hyaluronic acid in dental surgery:

1. Greater outcome predictability – xHyA stabilizes blood clot and attracts growth factors to support and accelerate hard and soft tissue formation.[1-4, 17,19]
2. Faster tissue healing – xHyA supports angiogenesis [1,10,19] & tissue formation [12,13,15-17] over an extended period. Its special formulation remains present throughout the various phases of the healing process due to its slow degradation pattern (several weeks).[17]
3. Lower risks of infection – xHyA’s high molecular weight reduces swelling and discomfort during the healing process.[18,19]
4. Better patient experience – xHyA’s high molecular weight reduces swelling and discomfort during the healing process. [18,19]
5. Better aesthetics – Support scar-less wound healing. [18,19]
6. User friendly – Apply directly on surgical site (in presence of blood), do not rinse. xHyA can be combined with Smartgraft to prepare the „sticky bone“ in 3 minutes.

What does cross-linked hyaluronic acid do?

The mode of action of hyaluronic acid

1. Attracts blood
2. Stabilizes coagulum and supports tissue regeneration
3. Bacteriostatic effect provides protection
4. Growth factors attracted by hyaluronic acid
5. Coordinates inflammation and accelerates angiogenesis

How to use hyaluronic acid gel?

Sticky bone in 3 minutes with xHyA gel and Smartgraft.

Deep Miller Class II gingival recession (Prof A Sculean) with cross-linked hyaluronic acid gel

+6+8

Infrabony defect (Prof A Pilloni) with a cross-linked hyaluronic acid gel

+1+3

GBR prior to implant placement (Prof D Bozic) with cross-linked hyaluronic acid gel and Smartbrane

+7+9

Pocket sealing after biofilm removal of a case affected by mucositis (Dr M Roncati)

+1+3

Soft tissue augmentation with cross-linked hyaluronic acid gel and Smartbrane (Dr M Pierchalla)

+4+6

How does pharmaceutical-grade cross-linked hyaluronic acid work?

The cross-linked hyaluronic acid gel is designed specifically for application in the field of dental surgery. xHyA, as one of the main components of the extracellular matrix, is naturally present in the human body [6-8]. Studies have shown that the prolonged presence of xHyA during the healing process promotes healing by regeneration rather than reparation [9,10].  Besides accelerating the healing of soft tissue and bone[11-13], the bacteriostatic properties of xHyA also protect the wound [5].

Cross-linked hyaluronic acid remains present throughout the various phases of the healing process due to its slow degradation pattern (several weeks) [14]. In addition, it aids the surgical periodontal treatment after application to the root surface and soft tissue. This leads to faster wound closure, substantial pocket reduction, and enhanced attachment [1,3-4]. When mixed with bone substitute material, such as Smartgraft, it forms an easily manageable putty, which may, in addition, lead to accelerated bone formation [15,16] and reduced swelling and pain. [18,19]

What is Hyadent BG?

+4+4

• Cross-linked hyaluronic acid gel (class III)
• Cartridge.of non-animal origin
• 2 x 1,2 ml ampulla
• Store at room temperature (2 °C – 25 °C).

Literature

1. King SR, Hickerson WL, Proctor KG. Beneficial actions of exogenous hyaluronic acid on healing. Surgery 1991;109(1):76-84
2. Kessiena L. Aya et al. ‘Hyaluronan in wound healing: Rediscovering a major player.’ Wound Rep Reg 2014;22:579-593. Dental Journal. (2017) Vol.42:104-
3. Fawzy ES. et al. Local application of hyaluronan gel in conjunction with periodontal surgery: a randomized controlled trial. Clin Oral Invest 2012;16:1229-1236
4. Briguglio, F. et al. Treatment of infrabony periodontal defects using a resorbable biopolymer of hyaluronic acid: A randomized clinical trial. Quintessence Int 2013;44:231-240
5. Pirnazar P. et al. ’Bacteriostatic effects of hyaluronic acid.’ Journal of Periodontology 1999;70:370-374
6. Lee JY, Spicer AP. ‘Hyaluronan: a multifunctional, megadalton, stealth molecule.’ Curr Opin Cell Biol 2000;12:581–586.
7. McDonald J, Hascall VC. ‘Hyaluronan mini review series.’ JBiol Chem 2002; 277:4575–4579.
8. Jiang D et al. ‘Hyaluronan as an immune regulator in human diseases.’ Physiol Rev 2011;91:221–264.
9. Longaker T et al. ‘Studies in Fetal Wound Healing: V. A prolonged presence of hyaluronic acid characterizes fetal wound healing’ Ann. Surg. 1991; April:292–296.
10. Mast BA et al. ‘Hyaluronic Acid Modulates Proliferation, Collagen and Protein Synthesis of Cultured Fetal Fibroblast’ Matrix, 1993;13:441–446.
11. Salbach J et al. ‘Regenerative potential of glycosaminoglycans for skin and bone.’ J Mol Med 2012;90:625–635.
12. Muzaffer A. et al. ‘The Effect of Hyaluronic Acid-supplemented Bone Graft in Bone Healing: Experimental Study in Rabbits ’ J Biomater Appl 2006 20:209
13. Sasaki T, Watanabe C, Bone. Vol. 16. No.1 January 1995:9-15
14. De Boulle K, Glogau R, Kono T, et al. ‚A Review of the Metabolism of 1,4-Butanediol Diglycidyl Ether– Crosslinked Hyaluronic Acid Dermal Fillers.’ Dermatologic Surgery 2013;39(12):1758-1766
15. Stiller M. et al. ‘Performance of β-tricalcium phosphate granules and putty, bone grafting materials after bilateral sinus floor augmentation in humans’ Biomaterials 2014;35(10):3154-3163.
16. Mendes RM et al. ‘Sodium hyaluronate accelerates the healing process in tooth sockets of rat’Arch Oral Biol 2008; 53:1155–1162
17. Shirakata Y, Imafuji T, Nakamura T, Kawakami Y, Shinohara Y, Noguchi K, Pilloni A, Sculean A. Periodontal wound healing/regeneration of two-wall intrabony defects following reconstructive surgery with cross-linked hyaluronic acid-gel with or without a collagen matrix: a preclinical study in dogs. Quintessence Int. 2021;0(0):308-316. doi: 10.3290/j.qi.b937003.
18. Yıldırım S, Özener HÖ, Doğan B, Kuru B. Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner-masked, randomized, controlled clinical trial. J Periodontol. 2018;89(1):36-45. doi:10.1902/jop.2017.170105
19. Pilloni A, Schmdlin PR, Sahrmann P, Sculean A, Rojas MA. ‘Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial, Clinical Oral Investigations, 2019 https://doi.org/10.1007/s00784-018-2537-4