구강 분야에서 히알루론산의 용도는 무엇입니까?

루 론 산  (HA) plays a crucial role in clinical applications, including moisture retention, lubrication, 그리고regulation 의osmotic pressure. It protects normal cells from toxic cells and free radicals, and stimulates cell migration, adhesion, proliferation, and differentiation [1]. 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.

측두하악관절 장애에서 히알루론산의 적용 1

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 주사is 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 etal. [4] conducted a systematic review of clinical randomised controlled trials evaluating SH treatment for temporomandibular 공동structural disorders. They found that SH significantly improved patients'단기와 장기 모두에서 최대 구강 개방, 그리고 단기간에 질병의 전반적인 임상 평가를 유의하게 향상시켰다;그러나, 그것의 장기적인 효과는 크지 않았다.glucocorticoids와 비교하여 SH는 우수한 단기 임상 전체 평가와 주사 후 부작용이 적다는 것을 입증했습니다.

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 자신의 히알루론산 생합성으로 통증 유발 물질을 제거합니다.

2   치주조직 질환에 히알루론산 적용

2. 1  플라케 유발 치은염에 히알루론산 적용

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.

2.2만성 치주염에 히알루론산 도포

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. 고분자 히알루론산 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.

근내막염에 히알루론산 적용 2.3

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

일부 연구자들은 비수술적 방법을 이용한 근내막염 치료에 대한 탐색적 연구를 수행하였다.기계적으로 플라크를 제거하고 SRP (scaling and root planing)를 실시한 뒤 0.2% 클로르헥시딘이 포함된 용액을 주입했다0.8% 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   상처 치유에 히알루론산 적용

3.  치아 추출 상처 치유에 히알루론산 적용

추출상처의 치유는 물리적, 화학적 상태, 호르몬, 약물과 같은 전신적, 국소적 요인뿐만 아니라 osteopontin (OPN), bone morphogenetic protein (BMP)-2, vascular endothelial growth factor (VEGF)를 포함한 일련의 성장인자에 의해서도 영향을 받는다.

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.

임플란트 상처 치유에 히알루론산 도포 3.2

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'통증 반응이다.이는 상처 정화, 항염증 효과, 상처 치유 촉진 등 상처 회복에 히알루론산 소금의 역할 때문인 것으로 사료된다.그것의 대사산물은 콜라겐 합성을 조절할 수 있을 뿐만 아니라 맥관 형성 및 섬유아세포의 증식을 촉진할 수 있다.Galli 등 15)은 히알루론산이 구강 임플란트 수술 후 상처 치유를 촉진한다는 사실을 발견하지 못했는데, 이는 후기 평가 시간 (수술 후 10일), 주관적인 점수 체계, 그리고 작은 샘플 크기와 관련이 있을 것으로 보인다.요약하면, 히알루론산이 임플란트 수술 후 상처 치유를 촉진할 수 있는지는 추후 연구를 통해 확인할 필요가 있다.

4  약물 전달 시스템에서의 히알루론산 응용

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.

재발성 아프타성 궤양에서의 히알루론산 적용 5

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.

참조

[1] 황실리, 구수핑, 양길란 외.최근 히알루론산 [J.식품과 의학, 2009년,11(1):50-53.

[2] 오래 X, 첸 G, 쳉아, et  알. 무작위 con-을 재판 of  우수 한 and  열등 temporomandibular joint  공간 injection  전방의 치료에 히알루론산으로 디스크 변위 without  [J] 감소 합니다. J  구강 Maxillofac Surg, 2009,  67 (2):357-361다.

[3] Escoda-Francoli J, Vzquez-Delgado E, Gay-Escoda 에 대한 과학적 증거 c   관골-하악 관리에 있어서 관절내 히알루론산 주사의 유용성 기능 장애다 [J다] 의대 경구 Patol 경구 Cir 2010년 Bucal, 15 (4):e644-e648.

리춘지, 장이판, 지아유안 등 [4].히알루론산나트륨을 이용한 측두하악관절 기능부전 치료에 대한 임상적 무작위 대조 실험에 대한 체계적 고찰 [J.서중국기공학회지 2011, 29(5):488-493.

[5] 류페이카이, 왕동, 펑청 등이 있다.측두하악관절 골관절염 환자의 활액내 matrix metalloproteinases 2 및 3에 미치는 sodium hyaluronate의 영향 (J).중국기문연구저널:전자판, 2011, 5(4):356-360.

[6] Zhao Jigang, Peng Guoguang, Liang Jingzhang 등이 있다.임상연구:슬관절 세척과 히알루론산나트륨 주사에 의한 고관절 골절의 수술 후 합병증 예방에 관한 연구 (J.현대기공학회지 2011, 25(2):105-107.

[7] 우야페이, 황자오, 쑤이 외.plaque-induced gingivitis의 치료에 있어서 Gengigel gel의 역할 (The role of Gengigel gel in The treatment of plaque-induced gingivitis)실천기공학회지 2005, 21(4):540-542.

[8] Sukumar S, Drizhal I. 히알루론산과 치주염 [J.「 Acta Medica 」 (Hradec Kralove), 2007, 50(4):225-228.

[9] Xu 이소연 Frentzen, M, Jerv Φ e-Storm 각형이다.만성 치주염 치료에서 히알루론산의 역할 [J.서중국기공학회지, 2004, 22(1):32-34.

[10] Fawzy El-Sayed KM, Dahaba MA, Aboul-Ela S 등.치주수술과 함께 히알루로난젤의 국소적 적용:무작위 대조 실험 [J].Clin Oral Investig, 2012, 16(4):1229-1236.

[11] 장리, 천강, 마리안 외.임상연구:sodium hyaluronate를 이용한 임플란트 주위 점막염의 치료에 관한 연구 (J.Chinese Journal of Oral Implantology, 2005, 10(1):22-24.

[12] Mendes RM, Silva GA, Lima MF 외.히알루론산 나트륨은 쥐의 치아 구멍에서 치료 과정을 가속화시킨다.구강생물학회지, 2008, 53(12):1155-1162.

[13] 장융팅, 탕궈화.추출 소켓의 치유에 대한 약물의 효과.구술자료와 악기, 2010, 19(2):104-107.

[14] 라이, H. B., &Y. Liu, implant 수술 후 상처 치유에서 히알루론산 젤의 역할 [J.광동기공학회지, 2008, 16 (보충):637-638.

[15] 갈리 F, 주페티 F, 까펠리 M 등.구강 내 외과적 절개의 치유를 향상시키기 위한 히알루론산:시험적 다기관 위약 대조 무작위 임상 시험. Eur J Oral Implantol, 2008, 1(3):199-206.

[16] 놀란 A, 베일리 C, 배드민턴 J 외.부제:The efficacy of topical hyaluronic acid in The management of recurrent aphthous ulcerationJ Oral Pathol Med, 2006, 35(8):461-465.

[17] Lee JH, Jung JY, Bang D. The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers:Comparison between recurrent aphthous ulcers and The oral ulcers of Behcet' s [J] 질병이다. J Eur Acad Dermatol Venereol, 2008, 22(5):590-595.