A randomized controlled trial evaluating hyaluronic acid gel as wound healing agent in alveolar ridge preservation

Recent Use of Hyaluronic Acid in Dental Medicine

This systematic review evaluates the clinical effectiveness of hyaluronic acid (HA) in periodontal therapy, oral surgery, and temporomandibular joint (TMJ) disorders. Background. HA, a biocompatible glycosaminoglycan with anti-inflammatory and regenerative properties, is increasingly used in dentistry to enhance healing, reduce pain, and support periodontal regeneration. However, its efficacy compared to conventional treatments remains debated. Materials and Methods. A systematic search was conducted following PRISMA guidelines across PubMed, Scopus, and Web of Science databases (2015-2025). Twenty-one clinical studies, including randomized controlled trials (RCTs) and case-control studies, were analyzed for outcomes related to pain reduction, tissue regeneration, and functional recovery. HA improved clinical attachment levels, reduced probing depth, and enhanced wound healing in periodontal therapy and oral surgery. It accelerated healing after extractions and frenectomies. However, TMJ disorder studies showed mixed results, with some reporting pain relief and functional improvement, while others found no significant advantage over platelet-rich plasma (PRP) or corticosteroids. Variability in HA formulations and protocols influenced outcomes. HA is a promising adjunct for periodontal therapy and wound healing. However, its role in TMJ treatment remains uncertain. Further RCTs with standardized protocols are needed to determine its optimal clinical application.

Herbal bioactive-loaded biopolymeric formulations for wound healing applications

Recent advancements in wound healing technologies focus on incorporating herbal bioactives into biopolymeric formulations. A biocompatible matrix that promotes healing is provided by biopolymeric wound dressings. These dressings use components such as ulvan, hyaluronic acid, starch, cellulose, chitosan, alginate, gelatin, and pectin. These natural polymers assist in three crucial processes, namely, cell adhesion, proliferation, and moisture retention, all of which are necessary for effective wound repair. Curcumin, quercetin, Aloe vera, Vinca alkaloids, and Centella asiatica are some of the herbal bioactives that are included in biopolymeric formulations. They have powerful anti-inflammatory, antibacterial, and antioxidant activities. Chitosan, cellulose, collagen, alginate, and hyaluronic acid are some of the biopolymers that have shown promise in clinical trials for wound healing. These trials have also confirmed the safety and functional performance of these materials. Their recent advancements in wound care can be understood by the increasing number of patents linked to these formulations. These innovative dressings improve healing outcomes in acute and chronic wounds while minimizing adverse effects by incorporating biopolymers with herbal bioactives in an efficient manner. This review emphasizes that the development of next-generation wound care products can be facilitated via the integration of natural materials and bioactive substances.

The Impact of Membrane Stabilization for Alveolar Ridge Preservation in Periodontally Compromised Extraction Sockets: A Non-Inferiority Randomized Controlled Trial

AIM

The aim of this study was to investigate the non-inferiority of alveolar ridge preservation (ARP) with membrane stabilization compared with non-stabilization, focusing on changes of soft-tissue contour in periodontally compromised extraction sockets. Secondary outcomes included changes in hard-tissue contour, patient-reported outcomes and new bone formation.

MATERIALS AND METHODS

Twenty-four patients with periodontally compromised teeth were randomly assigned to ARP with (test group) or without (control group) membrane stabilization. To assess profilometric and hard-tissue dimensional changes, dental impressions and cone beam computed tomography scans were performed at baseline (T0), immediately after ARP (T1) and 4 months post surgery (T2). Soft-tissue healing in open healing sites was evaluated at T2, and wound closure was assessed 10 days post surgery. Patient-reported outcomes were documented, and core biopsies were obtained for histomorphometric analysis.

RESULTS

The absolute profilometric horizontal width change at 3 mm below the crest in the test group was not inferior to that in the control group. For the relative values, horizontal width reduction (3 and 5 mm below the crest) and volumetric shrinkage (3-5 mm below the crest) were lower in the test group. No significant differences were observed in bone dimensional changes, wound healing, pain and swelling or histomorphometric outcomes.

CONCLUSION

ARP with membrane stabilization in periodontally compromised extraction sockets is non-inferior in terms of soft-tissue contour changes to those without membrane fixation.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS), KCT0005280. Registered 4 August 2020, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=19165&search_page=L.

The Role of Hyaluronic Acid in Alveolar Ridge Preservation: A Systematic Review of Its Biological and Regenerative Potential According to PRISMA Guidelines and the Cochrane Handbook

Objectives: This systematic review evaluates the biological activity and regenerative potential of hyaluronic acid (HA) in alveolar ridge preservation (ARP) following tooth extraction, assessing its efficacy in reducing bone resorption and promoting bone regeneration when combined with xenografts. Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Lilacs databases, adhering to PRISMA guidelines. Studies from 2012 to December 2024 involving human participants were included based on a PECO framework. Four studies met the inclusion criteria, with data extracted and analyzed for clinical and histological outcomes. The risk of bias was assessed using the ROBINS-E tool. Results: The included studies demonstrated that HA combined with xenografts significantly reduced post-extraction bone resorption compared to controls. HA-enhanced grafts showed superior radiographic and histological outcomes, including increased bone density and reduced graft shrinkage. While one randomized controlled trial found no significant differences in wound healing or patient-reported outcomes between HA and control groups, other studies reported improved bone formation and graft stability with HA. Variability in study design and sample size was noted, with a generally moderate to high risk of bias in some studies. Conclusions: The evidence supports the beneficial role of HA as an adjuvant in ARP procedures, enhancing bone regeneration and limiting resorption. However, further research with larger samples and standardized methodologies is required to confirm these findings and optimize clinical protocols.

Advancements in Hyaluronic Acid Effect in Alveolar Ridge Preservation: A Narrative Review

Background/Objectives: Tooth extraction induces significant alveolar ridge dimensional changes and soft tissue modifications, often leading to challenges in implant placement or conventional prosthetic rehabilitation. Alveolar Ridge Preservation (ARP) strategies aim to mitigate post-extraction resorption of the alveolar ridge, enhancing both the quality and quantity of bone and soft tissue during healing. Hyaluronic acid (HYA) has emerged as a promising biological agent for ARP due to its osteoinductive, antimicrobial, and anti-inflammatory properties. However, the effects of HYA in ARP remain inconsistently reported. This study aims to assess current clinical and preclinical evidence regarding the biological effects of HYA and its application in ARP. Additionally, it evaluates HYA's impact-alone or in combination with other products-on hard and soft tissue dimensional changes, early wound healing, and implant success rates. Methods: A comprehensive electronic literature search was conducted, and studies meeting the inclusion criteria were critically evaluated. Relevant data were extracted from the final selection of articles. Results: Thirteen publications were evaluated. Some studies reported a significantly improved newly formed bone following ARP with intra-socket HYA application as a single approach (p = 0.004). Combining HYA with a bone graft and a free palatal graft resulted in significantly greater amounts of newly formed and mature bone, reduced clinical bone width changes, lower radiographic crestal bone loss (p < 0.01), and diminished radiological volumetric and linear bone resorption (p = 0.018). Short-term follow-up data indicated improved soft tissue healing associated with HYA-based ARP. While HYA appears to have a protective effect on ridge dimensional changes in ARP, other studies reported no significant differences in radiographic bone dimensional changes or soft tissue improvement. Conclusions: The addition of HYA to bone grafts may enhance some ARP outcomes. However, the variability in outcomes and methodologies across the evaluated studies precludes drawing definitive clinical conclusions. Further robust research is needed to clarify HYA's role in ARP. With respect to clinical significance enhancing the understanding of ARP management strategies and their effects on post-extraction sockets empowers clinicians to make more informed decisions. The knowledge of HYA effects facilitates the selection of personalized ARP approaches tailored to optimize outcomes for subsequent interventions.

Novel Functional Dressing Materials for Intraoral Wound Care

Intraoral wounds represent a particularly challenging category of mucosal and hard tissue injuries, characterized by the unique structures, complex environment, and distinctive healing processes within the oral cavity. They have a common occurrence yet frequently inflict significant inconvenience and pain on patients, causing a serious decline in the quality of life. A variety of novel functional dressings specifically designed for the moist and dynamic oral environment have been developed and realized accelerated and improved wound healing. Thoroughly analyzing and summarizing these materials is of paramount importance in enhancing the understanding and proficiently managing intraoral wounds. In this review, the particular processes and unique characteristics of intraoral wound healing are firstly described. Up-to-date knowledge of various forms, properties, and applications of existing products are then intensively discussed, which are categorized into animal products, plant extracts, natural polymers, and synthetic products. To conclude, this review presents a comprehensive framework of currently available functional intraoral wound dressings, with an aim to provoke inspiration of future studies to design more convenient and versatile materials.

Hyaluronic Acid in Bone Regeneration: Systematic Review and Meta-Analysis

AIM

The aim of this systematic review and meta-analysis was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when hyaluronic acid (HA) was added and mixed with graft materials in bone regeneration.

MATERIALS AND METHODS

This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute of Health Research (registration number CRD42024530030). Electronic research was performed, and involved studies published up to 29 February 2024 using a specific word combination. The primary outcome was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when HA was added and mixed with graft materials in bone regeneration. The search resulted in 138 potential studies. Meta-analyses were performed using the fixed and random effects model to identify significant changes in new bone formation and in the remaining graft particles.

RESULTS

After screening procedures, only three randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. The effect size of HA in the new bone formation was not statistically significant at 95% CI (Z = 1.734, p-value = 0.083, 95 % CI -,399; 6516). The effect size of HA in the remaining graft particles was not statistically significant at 95% CI (Z = -1.042, p-value = 0.297, CI -,835; 255).

CONCLUSIONS

Within the limitations of the present systematic review and meta-analysis, the addition of HA to bone graft did not result in significant changes in bone regeneration procedures in terms of new bone formation and residues, even if the included studies showed encouraging and promising results.

A Randomized Controlled Trial Comparing Collagen Matrix to Hemostatic Gelatin Sponge as Socket Seal in Alveolar Ridge Preservation

(1) Objectives: This study aimed to compare a collagen matrix to a hemostatic gelatin sponge as a socket seal in alveolar ridge preservation (ARP). (2) Methods: Systemically healthy patients planned for ARP at two sites with more than 50% of the buccal bone wall remaining after tooth extraction were eligible for inclusion. ARP involved socket grafting using collagen-enriched deproteinized bovine bone mineral. Sites were then randomly assigned to the test group (collagen matrix) or the control group (hemostatic gelatin sponge). The primary outcome was soft tissue thickness in the center of the site at 4 months, analyzed on cone-beam computed tomography. Secondary outcomes included the buccal and lingual soft tissue heights, horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and Socket Wound Healing Score (SWHS). (3) Results: In total, 18 patients (12 females, 6 males) with a mean age of 57.3 years (SD 11.1) were included. Four months after ARP, the soft tissue thickness in the center of the site amounted to 2.48 mm (SD 0.70) in the test group and 1.81 mm (SD 0.69) in the control group. The difference of 0.67 mm (95% CI: 0.20-1.14) in favor of the collagen matrix was statistically significant (p < 0.009). The buccal soft tissue height was also statistically significantly higher for the collagen matrix (0.72 mm; 95% CI: 0.06-1.38; p = 0.034). A trend favoring the collagen matrix was found for the lingual soft tissue height (p = 0.066). No significant differences between the groups in terms of horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and the SWHS were found. (4) Conclusions: The absence of significant differences in hard tissue outcomes suggests that both the collagen matrix and hemostatic gelatin sponge effectively sealed the extraction socket and supported bone preservation. However, the collagen matrix better maintained soft tissue dimensions. The clinical relevance of this finding with respect to the necessity for adjunctive soft tissue augmentation at the time of implant placement is yet to be studied.

Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes

This narrative review systematically explores the progression of materials and techniques in alveolar ridge preservation (ARP). We commence by delineating the evolution from traditional ARP methods to cutting-edge alternatives, including platelet-rich fibrin, injectable bone repair materials, and hydrogel systems. Critical examination of various studies reveals these innovative approaches not only accelerate bone healing but also significantly improve patient-reported outcomes, such as satisfaction, pain perception, and overall quality of life. Emphasis is placed on the correlation between advanced ARP techniques and enhanced patient comfort and clinical efficacy, underscoring their transformative potential in dental implantology. Highlighting the effectiveness of ARP, the implant survival rate over a span of 5 to 7 years was high, showcasing the reliability and success of these methods. Further, patients expressed high aesthetic satisfaction with the soft tissue outcome, evidenced by an average visual analog scale (VAS) score of 94. This positive aesthetic appraisal is linked to the clinical health of implants, potentially due to the employment of tooth-supported surgical guides. The economic analysis reveals a varied cost range for bone graft substitutes ($46.2 to $140) and socket sealing materials ($12 to $189), with a noteworthy correlation between the investment in barrier membranes and the diminished horizontal and vertical ridge resorption. This suggests that membrane usage significantly contributes to preserving ridge dimensions, offering a cost-effective strategy for enhancing ARP outcomes. In conclusion, this review illuminates the significant advancements in ARP, highlighting the shift towards innovative materials and techniques that not only promise enhanced bone regeneration and reduced healing times but also improve patient satisfaction and aesthetic outcomes. The documented high implant survival rate and the beneficial economic implications of membrane use further validate the effectiveness of contemporary ARP strategies, paving the way for their broader adoption in dental implantology.

Hyaluronic acid in tooth extraction: a systematic review and meta-analysis of preclinical and clinical trials

OBJECTIVES

To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.

MATERIALS AND METHODS

Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.

RESULTS

Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.

CONCLUSIONS

HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.

CLINICAL RELEVANCE

HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.

Biomaterials for Alveolar Ridge Preservation as a Preoperative Procedure for Implant Treatment: History and Current Evidence

In implant treatment, the reduction and structural changes in the alveolar ridge that occur after tooth extraction limit the length, width, and placement position of the implant body, impair esthetics, and, in some cases, make implant placement difficult. To solve these problems, an alveolar ridge preservation (ARP) technique, which is performed simultaneously with tooth extraction, generally aims to promote bone regeneration and prevent alveolar ridge reduction by filling the extraction socket with bone graft material and then covering it with a barrier membrane to protect against the invasion of epithelial tissue. The extraction socket provides a favorable environment for bone regeneration throughout the healing period because the blood supply is abundant, and it effectively retains the bone graft material by using the remaining bone wall of the socket. In recent years, advances in bioengineering technology have led to the development of graft materials with various biological properties, but there is currently no clear consensus regarding the selection of surgical techniques and materials depending on the condition of the alveolar ridge. This review will provide a comprehensive survey of the evidence accumulated to date on ARP, present many cases according to the clinical situation, and discuss various treatment options.

Hyaluronic acid-mediated collagen intrafibrillar mineralization and enhancement of dentin remineralization

Non-collagenous proteins (NCPs) in the extracellular matrix (ECM) of bone and dentin are known to play a critical regulatory role in the induction of collagen fibril mineralization and are embedded in hyaluronic acid (HA), which acts as a water-retaining glycosaminoglycan and provides necessary biochemical and biomechanical cues. Our previous study demonstrated that HA could regulate the mineralization degree and mechanical properties of collagen fibrils, yet its kinetics dynamic mechanism on mineralization is under debate. Here, we further investigated the role of HA on collagen fibril mineralization and the possible mechanism. The HA modification can significantly promote intrafibrillar collagen mineralization by reducing the electronegativity of the collagen surface to enhance calcium ions (Ca2+) binding capacity to create a local higher supersaturation. In addition, the HA also provides additional nucleation sites and shortens the induction time of amorphous calcium phosphate (ACP)-mediated hydroxyapatite (HAP) crystallization, which benefits mineralization. The acceleration effect of HA on intrafibrillar collagen mineralization is also confirmed in collagen hydrogel and in vitro dentin remineralization. These findings offer a physicochemical view of the regulation effect of carbohydrate polymers in the body on biomineralization, the fine prospect for an ideal biomaterial to repair collagen-mineralized tissues.

Clinical and radiographic assessment of cross-linked hyaluronic acid addition in demineralized bovine bone based alveolar ridge preservation: A human randomized split-mouth pilot study

PURPOSE

To investigate clinically and radiographically at 4 months post-operatively the outcomes of mixing demineralized bovine bone material (DBBM) with cross-linked hyaluronic acid in alveolar ridge preservation.

MATERIAL AND METHODS

Seven patients presenting bilateral hopeless teeth (14 teeth) were enrolled in the study, the test site contained demineralized bovine bone material (DBBM) mixed with cross-linked hyaluronic acid (xHyA) while the control site contained only DBBM. 4 months post-operatively prior to implant placement a Cone beam computed tomography (CBCT) scan was recorded and compared to the initial scan to assess the volumetric and linear bone resorption that occurred in both sites. Clinically, sites that needed further bone grafting at the implant placement stage were recorded. Differences in volumetric and linear bone resorption between both groups were assessed using Wilcoxon signed rank test. McNemar test was also used to evaluate difference in bone grafting need between both groups.

RESULTS

All sites healed uneventfully, volumetric and linear resorption differences between the baseline and 4 months post-operatively were obtained for each site. The mean volumetric and linear bone resorption were respectively 36.56 ± 1.69%, 1.42 ± 0.16 mm in the controls sites and 26.96 ± 1.83%; 0.73 ± 0.052 mm in the tests sites. The values were significantly higher among controls sites (P=0.018). No significant differences were observed in the need for bone grafting between both groups.

CONCLUSION

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

Clinical Performance Evaluation of a Hyaluronic Acid Dental Gel for the Treatment of Traumatic Ulcers in Patients with Fixed Orthodontic Appliances: A Randomized Controlled Trial

BACKGROUND

A newly available gel containing hyaluronic acid (HA) and polyvinylpyrrolidone was tested for efficacy on traumatic oral ulcers (TOU) caused by fixed orthodontic appliances.

METHODS

A double-blind RCT was conducted to test the new gel versus a placebo. According to the sample size calculation, a total of 60 patients were considered sufficient and randomly allocated to one of the two groups out of a pool of 100 total patients who initially agreed to participate in the study. A VAS scale test and lesion measurements at T0, T1, and T2 were performed on the patients.

RESULTS

A total of 70 patients developed TOU, with 8 drop-outs; the intergroup comparison showed a statistically significant greater dimension of the lesion in the control group at T2 when compared to the test group. The pain experienced by the patients belonging to the test group was significantly lower than the pain in the patients in the control group Conclusions: Under the limitations of the study, the new formula might provide faster healing with less pain experienced by the patient when compared to a placebo.