Quelle est l’utilisation de l’acide hyaluronique dans le domaine Oral?

Acide hyaluronique  (HA) plays a crucial role in clinical applications, including moisture retention, lubrication, Et en plusregulation De laosmotic pressure. It protects normal cells from toxic cells and free radicals, and stimulates cell migration, adhesion, proliferation, and differentiation [1] [traduction]. 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 Application d’acide hyaluronique dans les troubles de l’articulation temporomandibulaire

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 l’injectionis 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 Et etal. [4] conducted a systematic review of clinical randomised controlled trials evaluating SH treatment for Articulation temporo-mandibulairestructural disorders. They found that SH significantly improved patients' Ouverture maximale de la bouche à court et à long terme, et amélioration significative de l’évaluation clinique globale de la maladie à court terme; Cependant, ses effets à long terme n’étaient pas significatifs. Comparée aux glucocorticoïdes, la SH a démontré une évaluation clinique globale à court terme supérieure et moins d’effets indésirables après injection.

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 propre biosynthèse d’acide hyaluronique pour éliminer les substances causant la douleur.

2   Application d’acide hyaluronique dans les maladies du tissu parodontal

2.1. -  Application d’acide hyaluronique dans la gingivite induite par la peau

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 Application d’acide hyaluronique dans la parodontite chronique

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. Acide hyaluronique à poids moléculaire élevé 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 Application de l’acide hyaluronique en péri-implantite

Peri-implant mucositis is an early stage of peri-implantitis, with inflammation confined to the gingival mucosa around the implant, sansbone 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.

Certains chercheurs ont mené des études exploratoires sur le traitement de la péri-implantite à l’aide de méthodes non chirurgicales. Après avoir éliminé mécaniquement la plaque et effectué le tartrage et le rabotage des racines (SRP), ils ont injecté une solution contenant 0,2% de chlorhexidine et0.8% 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   Application d’acide hyaluronique dans la cicatrisation des plaies

3.1. - les conditions de travail  Application d’acide hyaluronique dans la guérison des plaies d’extraction dentaire

La cicatrisation des plaies d’extraction est influencée non seulement par des facteurs systémiques et locaux tels que des conditions physiques et chimiques, des hormones et des médicaments, mais aussi par une série de facteurs de croissance, y compris l’ostéoponnine (OPN), la protéine morphogénétique osseuse (BMP)-2, et le facteur de croissance endothéliale vasculaire (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 Application d’acide hyaluronique dans la cicatrisation des plaies implantaires

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' Réponses à la douleur. Cela est attribué au rôle des sels d’acide hyaluronique dans la réparation des plaies, y compris le nettoyage des plaies, les effets anti-inflammatoires et la promotion de la cicatrisation des plaies. Ses produits métaboliques peuvent favoriser la vascularisation et la prolifération des fibroblastes, ainsi que réguler la synthèse du collagène. Galli et coll. [15] n’ont pas constaté que l’acide hyaluronique favorise la cicatrisation des plaies après la chirurgie par implant buccal, ce qui peut être lié au temps d’évaluation tardive (10 jours après la chirurgie), au système de notation subjective et à la petite taille de l’échantillon. En résumé, il reste à confirmer par d’autres études si l’acide hyaluronique peut favoriser la cicatrisation des plaies après la chirurgie de l’implant.

4  Application de l’acide hyaluronique dans des systèmes d’administration de médicaments

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 Application d’acide hyaluronique dans les ulcères aphtes récurrents

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.

Références:

[1] Huang Sili, Guo Xueping, Yang Guilan et al. Progrès récents dans l’application de l’acide hyaluronique [J]. Food and Medicine, En 2009,11(1): 50-53.

[2] [traduction] Longue durée X, Mon - sun G, Cheng AH, et  Al. A randomisé Contrôle — contrôle procès of  supérieure and  inférieur temporomandibular joint  l’espace injection  Avec l’acide hyaluronique dans le traitement de antérieure disque déplacement without  Réduction [J]. J J J  Maxillofac Oral Surg, 2009,  67(2):357-361.

[3] [traduction] Escoda-francol[unused_word0006] J, Vzquez-Delgado E, E, Gay-Escoda C.preuves scientifiques sur la   Utilité de l’injection d’acide hyaluronique intra-articulaire dans la gestion des Dysfonctionnement [J]. Ce qui est Par voie orale Le Patol Par voie orale Le Cir Bucal, 2010, 15(4):e644-e648.

[4] Li Chunjie, Zhang Yifan, Jia Yuanyuan et al. Une revue systématique d’un essai clinique contrôlé randomisé sur le traitement du dysfonctionnement de l’articulation temporomandibulaire avec l’hyaluronate de sodium [J]. West China Journal of Stomatology, 2011, 29(5): 488-493.

[5] Liu Peicai, Wang Dong, Peng Cheng, et al. Effets de l’hyaluronate de sodium sur les métalloprotéinases 2 et 3 de la matrice dans le liquide synovial de patients atteints d’arthrose de l’articulation temporomandibulaire [J]. Chinese Journal of Stomatological Research: édition électronique, 2011, 5(4): 356-360.

[6] Zhao Jigang, Peng Guoguang, Liang Jingzhang, et al. Étude clinique sur la prévention des complications postopératoires d’une fracture condylar par lavage articulaire et injection d’hyaluronate de sodium [J]. Journal of Modern Stomatology, 2011, 25(2): 105-107.

[7] Wu Yafei, Huang Jiao, Xu Yi et al. Le rôle du gel Gengigel dans le traitement de la gingivite induite par la peau [J]. Journal of Practical Stomatology, 2005, 21(4): 540-542.

[8] Sukumar, S., de zhal I. acide hyaluronique et parodontite [J]. Acta Medica (Hradec Kralove), 2007, 50(4): 225-228.

[9] Xu Yi, Frentzen M, jervφe-storm P-M. Rôle de l’acide hyaluronique dans le traitement de la parodontite chronique [J]. West China Journal of Stomatology, 2004, 22(1): 32-34.

[10] Fawzy El-Sayed KM, Dahaba MA, Aboul-Ela S, et al. Application locale de gel d’hyaluronan en association avec la chirurgie parodontale: un essai contrôlé randomisé [J]. Clin Oral Investig, 2012, 16(4): 1229-1236.

[11] Zhang Li, Chen Gang, Ma Lian, et al. Étude clinique sur le traitement de la mucosite péri-implant avec de l’hyaluronate de sodium [J]. Chinese Journal of Oral Implantology, 2005, 10(1): 22-24.

[12] Mendes RM, Silva GA, Lima MF, et al. L’hyaluronate de Sodium accélère le processus de guérison dans les orbites dentaires des rats [J]. Archives of Oral Biology, 2008, 53(12): 1155-1162.

[13] Zeng Yunting, Tang Guohua. L’effet des médicaments sur la guérison des prises d’extraction [J]. Oral Materials and Instruments, 2010, 19(2): 104-107.

[14] Lai, H. B., & Liu, Y. The role of hyaluronic acid gel in wound healing after implant surgery [J]. Guangdong Journal of Stomatology, 2008, 16 (supplément): 637-638.

[15] Galli F, Zuffetti F, Capelli M, et al. L’acide hyaluronique pour améliorer la guérison des incisions chirurgicales dans la cavité buccale: un essai clinique pilote multicentrique randomisé contrôlé contre placebo [J]. Eur J Oral Implantol, 2008, 1(3): 199-206.

[16] Nolan A, Baillie C, Badminton J, et al. L’efficacité de l’acide hyaluronique topique dans la prise en charge des ulcères aphteux récurrentes [J]. J Oral Pathol Med, 2006, 35(8): 461-465.

[17] Lee JH, Jung JY, Bang D. l’efficacité du gel d’acide hyaluronique topique à 0,2% sur les ulcères buccaux récurrents: comparaison entre les ulcères aphtes récurrents et les ulcères buccaux de beh et' S maladie [J]. J Eur Acad Dermatol Venereol, 2008, 22(5): 590-595.