Hyaluronic Acid
Anti-inflammatory
Protective tissue barrier against bacteria
Speeds healing process
What is hyaluronic acid?
High molecular weight hyaluronic acid (HA) is a natural physiological constituent of connective tissue.
It plays a critical role in the collagen-making process. Made up mostly of collagen, it is one of the major
components of the human body. HA is the most abundant high molecular weight glycosaminoglycan of healthy
soft periodontal tissues.4 It is active in tissue regeneration and influences the migration of fibroblasts and
fibrinogenesis, thus making the healing of tissue easier. It performs 3 synergistic effects: anti-inflammatory,
accelerates the healing process and provides a protective barrier.
Contributing to the barrier function and tensile strength of the periodontal ligament, HA is essential for healthy
gingival tissues. In the initial stage of inflammation and periodontal disease, tissue’s requirement for HA
increases by 200%, demonstrating its central role in regulating cell turnover and optimizing tissue regeneration.
When lacking HA, healing will be delayed and inflammation will continue
Phases of Hyaluronic Acid in Tissue Healing
1. ANTI-INFLAMMATORY PHASE
• Enhanced inflammatory cell and extracellular matrix cell infiltration into the inflamed site
• Elevation of pro-inflammatory cytokine production by damaged tissue
• Stabilizes granulation tissue matrix
• Scavenges free radicals such as superoxide (O2) and hydroxyl radical (OH)
• Inhibition of inflammatory cell-derived proteinases
2. GRANULATION PHASE
• Increases organisation of the granulation tissue matrix
• Increases extracellular matrix cell proliferation
• Increases inflammatory cell and extracellular matrix cell migration
• Increases blood vessel formation (angiogenesis)
3. REPARATIVE PHASE
• Increased fibroblasts and collagen
• Fibrous tissue formation
• Migration and proliferation of keratinocytes
• Rapid epithelialisation and wound healing
References
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- Rahemtulla F., Proteoglycans of oral tissues, Crit Rev Oral Biol Med 1992;3:135-162. [abstract]
- Salazar Monsalve L, Rodríguez Lara V, González Villalva AE. En Fortoul T, Castell A., Histología y biología celular, McGrawHill México, 1ª ed. 2010. Capítulo 5: Tejidos. [link]
- Sukumar S, Drízhal I., Hyaluronic acid and periodontitis, Acta Medica (Hradec Kralove) 2007;50:225-258. [link]
- Weigel PH, Hascall VC, Tammi M., Hyaluronan Synthases, J Biol Chem 1997;272(22):13997-14000.[abstract]
- Hascall VC, Laurent TC., Hialuronan: Structure and physical properties, 1997. [link]
- Silvera Arenas LA, Barrios de Zurbarán C., La matriz extracelular: el ecosistema de la célula Salud Uninorte. Barranquilla 2002;16:9-18. [link]
- Choukroun J, Diss A, Simonpieri A et al., Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part IV: Clinical effects on tissue healing Med Oral Pathol Oral Radiol Endod 2006; 101:E56-E60. [link]
- Weigel PH, Fuller GM, Le-Boeuf RD., A model for the role of hyaluronic acid and fibrin in the early events during the inflammatory response and wound healing, J Theor Biol 1986;119(2):219-234. [link]
- Sakasi T, Watanabe C., Stimulation of osteoinduction in bone wound healing by high-molecular hyaluronic acid, Bone 1995;16:9-15. [link]
- Pirnazar P, Wolinsky L, Nachnani S et al., Bacteriostatic effects of hyaluronic acid, J Periodontol 1999;70:370-374. [download]
- Sakai A, Akifusa S, Itano N et al., Potential role of high molecular weight hyaluronan in the anti-Candida activity of human oral epithelial cells, Med Mycil Feb 2007;45(1):73-79. [link]