Hyaluronic acid in dentistry

Boosting dental regeneration

Hyaluronic acid is an essential component of our soft and hard tissues. As such it is found in all tooth-supporting structures, which demonstrates its role in periodontal and alveolar bone regeneration. Thanks to its water retaining and gel forming activities it has also become the focus of tissue engineering in cosmetics and many biomedical fields.

Learn more about hyaluronic acid’s significance in tissue homeostasis and its use in biomaterials.

Guiding regeneration – Hyaluronic acid biofunctionalization
Hyaluronic acid is widely distributed throughout the human body as one major component of the extracellular matrix of many organs and tissues such as skin, muscles, tendon, gingiva and alveolar bone. Hyaluronic acid has a multitude of structural and cell regulatory functions including stimulation of angiogenesis, modulation of the immune response and regulation of intercellular communication1.

Key component of the body’s tissues
Hyaluronic acid is capable to retain huge amounts of liquids to form a hydrogel with high viscosity. As such it appears as a macroporous scaffold, which regenerative cells can occupy and permeate. Hyaluronic acid is therefore found in many important tissues of the human body providing mainly mechanical support, maintaining tissue integrity and providing a moisturizing effect.

Water binds to hyaluronic acid through hydrogen bonds. Based on experimental measurements, it is estimated that about 14 (±5) water molecules are bound per disaccharide repeating unit2.

Dental products
with hyaluronate

cerabone® plus combines the established bovine bone grafting material cerabone® with the well-known properties of hyaluronic acid. Thanks to the pronounced liquid binding capacities of hyaluronate, cerabone® plus forms a sticky bone material upon hydration that provides unique application comfort by allowing both easy uptake and delivery to the site of application.

A multifaceted biopolymer for tissue engineering
Owing to its unique chemical nature hyaluronic acid has become an attractive agent in the field of tissue engineering. Many free binding sites of the biomolecule offer potential spots for chemical reactions to create hyaluronic acid with slower degradation properties, which thus can serve as vehicle for bioactive components such
as growth factors and pharmaceuticals3. Therefore, hyaluronic acid is used in different biomedical fields , for example for the treatment of vascular diseases as well as cartilage-, bone-, and soft tissue defects4.

Read more about:
Hyaluronic Acid Production – State-Of-The-Art And Future Perspectives

Hyaluronic acid disaccharide unit

„Hyaluronic acid has been shown to enhance the proliferative, migratory and wound healing properties of cell types involved in soft tissue wound healing thus pointing to its potential indication in oral reconstructive procedures.“

Prof. Dr. Anton Sculean, University of Bern, Switzerland

Regulating inflammation
Hyaluronic acid has been used for the treatment of chronic wounds and inflammatory disorders like gingivitis, chronic periodontitis and degenerative joint diseases.

Boosting wound repair: Hyaluronic acid

  • Stimulates the formation of new blood vessels and thus provides the basis for optimal oxygen and nutrients supply to the wound5
  • Acts as an anti-oxidant and binds cell-damaging oxygen radicals thereby supporting cell survival and cell multiplication6
  • Provides a matrix guiding the migration and adhesion of cell types involved in the clearance of the wound from damaged cells and invaded microbes such as granulocytes and macrophages7

Read more about:
The Role of Hyaluronic Acid in Wound Healing

Human osteoblasts attached to cerabone® plus.
Green: cell actin cytoskeleton; blue: cell nuclei. Image from Qasim SSB et al., J Biomater Sci Polym Ed. 2024 Apr;35(6):880-897.12

Expert Talk

Prof. Sofia Aroca, Prof. Serhat Aslan and
Dr. Miguel Stanley about cerabone® plus
Three experts in their field provide insight into how the application comfort of cerabone® plus improves their daily practice and facilitates the treatment of complex bone defects. See the video

Present in all tooth-supporting tissues
Hyaluronic acid is found both in the non-mineralized and mineralized tissues of the periodontium. As the predominant glycosaminoglycan in the gingiva, it is present in high quantities in the gingival epithelium and connective tissue as well as the gingival crevicular fluids8, 9. In the periodontal ligament it is embedded in the connective tissue matrix. Within the alveolar process hyaluronic acid is a component of the non-mineralized, organic part of the bone.

Hyaluronic acid is an essential component of the gingiva, the periodontal ligament, and the alveolar bone, which indicates its role in oral soft and hard tissue regeneration.

botiss campus

Learn from the experts

Find out about the latest publications in the field, watch surgical videos and take part in webinars with international experts. Learn how to get the maximum impact for your dental practice and how to benefit from the advantages of the combination of bone grafting materials with hyaluronic acid.

Orchestrating tissue regeneration
Hyaluronic acid interacts with many cell types involved in wound repair and immunological processes and thus is regarded as a catalyst for tissue regeneration. Cell-to-hyaluronic acid communication and interaction take place at multiple levels, which reflects the significance of the molecule for tissue homeostasis. Hyaluronic acid supports cell adhesion and -migration and stimulates cell proliferation and -differentiation. On a molecular level, membrane-based glycoproteins bind to hyaluronic acid, which triggers signal transduction and in turn cell activation10.

The ideal bone grafting material
Usability and grafting efficacy are emerging key aspects when it comes to the requirements for the ‘ideal’ bone substitute material. Handling characteristics of bone regeneration materials can be significantly improved by organic additives, with hyaluronic acid being of particular interest, because of its water-binding activities. Moreover, the performance of bone substitutes can benefit from its well described biological functions11.

Data from Rakaševic D et al., J Funct Biomater. 2023 Mar 8;14(3):149.13

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Clinical casebook cerabone® plus

Featuring 14 detailed clinical cases and histological results this casebook provides insights into solving both everyday and advanced clinical challenges.

  1. Stern, R., Asari, A. A. & Sugahara, K. N. Hyaluronan fragments: an information-rich system. Eur J Cell Biol 85, 699715 (2006).
  2. Borchers, S. & Pirrung, M. The Fallacy of Hyaluronic Acid Binding a Thousand Times Its Weight In Water. Preprint at https://doi.org/10.26434/chemrxiv-2023-r728q (2023).
  3. Zhai, P. et al. The application of hyaluronic acid in bone regeneration. Int J Biol Macromol 151, 12241239 (2020).
  4. Zhu, Z., Wang, Y.-M., Yang, J. & Luo, X.-S. Hyaluronic acid: a versatile biomaterial in tissue engineering. PAR 4, 219 (2017).
  5. Sattar, A. et al. Application of Angiogenic Oligosaccharides of Hyaluronan Increases Blood Vessel Numbers in Rat Skin. Journal of Investigative Dermatology 103, 576579 (1994).
  6. Pauloin, T., Dutot, M., Joly, F., Warnet, J.-M. & Rat, P. High molecular weight hyaluronan decreases UVB-induced apoptosis and inflammation in human epithelial corneal cells. Mol Vis 15, 577583 (2009).
  7. McKee, C. M. et al. Hyaluronan (HA) fragments induce chemokine gene expression in alveolar macrophages. The role of HA size and CD44. J. Clin. Invest. 98, 24032413 (1996).
  8. Kedige, S., Anand, S. & Bansal, J. Hyaluronic acid: A promising mediator for periodontal regeneration. Indian J Dent Res 21, 575 (2010).
  9. Embery, G., Waddington, R. J., Hall, R. C. & Last, K. S. Connective tissue elements as diagnostic aids in periodontology: Connective tissue elements as diagnostic aids in periodontology. Periodontology 2000 24, 193214 (2000).
  10. Queisser, K. A., Mellema, R. A. & Petrey, A. C. Hyaluronan and Its Receptors as Regulatory Molecules of the Endothelial Interface. J Histochem Cytochem. 69, 2534 (2021).
  11. Dogan, E. et al. Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis. Int J Oral Maxillofac Surg 46, 931937 (2017).
  12. Qasim, S. S. B., Trajkovski, B. & Zafiropoulos, G.-G. The response of human osteoblasts on bovine xenografts with and without hyaluronate used in bone augmentation. Journal of Biomaterials Science, Polymer Edition 35, 880897 (2024).
  13. Rakašević, D. et al. Reconstructive Peri-Implantitis Therapy by Using Bovine Bone Substitute with or without Hyaluronic Acid: A Randomized Clinical Controlled Pilot Study. JFB 14, 149 (2023).

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