Does adding Hyaluronic Acid (HA) improve regenerative outcomes?

This Week in Implants
1

This Week in Dental Implants we are focusing on the role of Hyaluronic acid (HA) in regenerative dentistry.

What is Hyaluronic acid (HA)?

Hyaluronic acid (HA) is a naturally occurring, highly hydrophilic polysaccharide that can be applied in dental and oral‑surgical grafting as a liquid, gel, or cross‑linked formulation. In the studies listed it is used either alone or mixed with bone‑substitutes, collagen matrices, or synthetic membranes.

Is Hyaluronic acid (HA) helpful in regenerative procedures?

Across a range of animal and human studies, as summarized below, HA was shown to:

  • reduce dimensional loss of grafted bone,
  • increase bone density and new‑bone formation,
  • improve soft‑tissue stability and integration,
  • accelerate wound healing on donor sites,
  • enhance clinical outcomes in peri‑implant disease treatment.

Case Study: Alveolar ridge preservation with hyaluronic acid-enriched allografts

Case below by Frank R Kloss,Thomas Kau,Diana Heimes et al., International journal of implant dentistry. Volume: 10, Issue: 1, 2024 Enhanced alveolar ridge preservation with hyaluronic acid-enriched allografts: a comparative study of granular allografts with and without hyaluronic acid addition..

Initial Situation
Initial Situation600×257 18.8 KB

Initial clinical situation. The sectional image of the CBCT, along with the recession on tooth 11, reveals a class III defect according to Kim et al. [3]. The mucosa appears inflamed, and an extensive loss of the buccal alveolar wall is visible

Hyaluronic acid enriched allograft.
Hyaluronic acid enriched allograft.600×562 60.5 KB

Hyaluronic acid enriched allograft. Figure C shows the allogenic granules mixed with powdered hyaluronic acid. Adding sterile NaCl solution (Figure D) produces a moldable mass known as “sticky bone” (Figure E)

Alveolar ridge preservation.
Alveolar ridge preservation.600×520 53.7 KB

Alveolar ridge preservation. Tooth extraction (Figure F) revealed apical granulation. After mechanical cleaning, the socket was filled with allogenic bone substitute mixed with hyaluronic acid (Figure G). To optimize soft tissue healing, a PRF plug was placed in the socket and secured with a situational suture (Figure H). The postoperative control image (Figure I) shows the vestibular oversizing of the inserted material

Final situation.
Final situation.567×600 56.4 KB

Final situation. After 4 months, when the surgical site was reopened (Figure J), a completely regenerated alveolar ridge was revealed. The alveolus showed complete radiological regeneration (Figure K), allowing for straightforward implant placement. Figure L illustrates the final prosthetic restoration with irritation-free mucosa conditions after one year

3D-Model
3D-Model600×583 21 KB

3D-Model for visualizing the mathematical approach of calculating the volume of the defect

In conclusion, our study demonstrates that adding hyaluronic acid to allogeneic bone substitutes in ridge preservation leads to enhanced graft stability, reduced shrinkage rate, and increased bone density. These findings highlight the potential of hyaluronic acid to optimize ridge preservation procedures and promote successful implant integration

Additional Recent Studies

Cross-linked hyaluronic acid (xHyA) appears to limit the post-extractional alveolar bone resorption when mixed with DBBM.

HA also promotes angiogenesis and represents a viable, cost-effective alternative that does not require blood collection. Both PRF and HA biofunctionalization may offer potential benefits for enhancing vascularization in GBR/GTR applications.

Within the limits of this case series, we conclude that the proposed treatment sequence substantially improved peri-implant defects and offered a simplified but predictive technique. Reconstructive treatment approaches for peri-implantitis are effective but remain non-superior to open flap debridement. Further research on novel biomaterial combinations that may improve reconstructive treatment outcomes are warranted. Ribose-crosslinked collagen matrices biofunctionalized by hyaluronic acid used in this study yield improved clinical and radiographic peri-implant conditions after 12 months.

The results of the study 12 months after the periimplant zone remodeling operation procedure prove the efficacy of HAP and TCF modified with hyaluronic acid for the treatment of patients with periimplantitis.

The effectiveness of using HA gel in reducing the black triangle area was 85.06%. Furthermore, the papilla length increased by 70.256% while contact to papilla distance decreased by 83.026%. At different times, the values of the studied variables in the three levels were significantly different (p< 0.05). Injection of HA with 1.6% concentration at two points of the interdental papilla was effective in interdental papilla reconstruction at the aesthetic zone, especially in long-term, follow-ups (especially 6 months).

The results of the study 12 months after the periimplant zone remodeling operation procedure prove the efficacy of HAP and TCF modified with hyaluronic acid for the treatment of patients with periimplantitis.

CY application reduces pain and analgesic intake and HA may support the wound healing with increased EL. Using the CY-HA combination provides additional benefits for donor site management.

Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.