口腔におけるヒアルロン酸の使用は何ですか?

ヒアルロン酸  (HA) plays a crucial role in clinical applications, including moisture retention, lubrication, とregulation のosmotic 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.

1顎関節障害におけるヒアルロン酸の応用

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 注射is 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 あごの関節structural disorders. They found that SH significantly improved patients'短期的にも長期的にも口の開口率を最大化し、短期的にも病気の全体的な臨床評価を大幅に向上させます;しかし、長期的な影響はあまり大きくなかった。本剤は、グルココルチコイドと比較して、短期臨床評価全体で優れており、注射後の副作用が少ないことが確認されました。

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&#痛みの原因物質を排除するために39の独自のヒアルロン酸生合成。

2   歯周組織疾患におけるヒアルロン酸の応用

2.1  プラーク誘発歯肉炎におけるヒアルロン酸の応用

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ヒアルロン酸の慢性歯周炎への応用

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. High-molecular-weightヒアルロン酸 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 .インプラント周囲炎におけるヒアルロン酸の応用

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

いくつかの研究者は、非外科的な方法を用いて、インプラント周囲炎の治療について探索的な研究を行っている。機械的にプラークを除去し、スケーリングアンドルートプレーニング(srp)を行った後、0.2%のクロルヘキシジンを含む溶液を注入した0.8% 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   ヒアルロン酸の創傷治癒への応用

3.1  歯の抽出創傷治癒におけるヒアルロン酸の応用

抽出創傷の治癒は、物理的、化学的条件、ホルモン、薬物などの全身的および局所的な要因だけでなく、オステオポンチン(opn)、骨形成タンパク質(bmp)-2、血管内皮増殖因子(vegf)などの一連の成長因子にも影響される。

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インプラント創傷治癒へのヒアルロン酸の応用

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'痛み回答が寄せられた。これは、ヒアルロン酸塩が、創傷の浄化、抗炎症効果、創傷治癒の促進など、創傷修復に果たす役割に起因しています。その代謝産物は、血管新生と線維芽細胞の増殖を促進し、コラーゲン合成を調節する。galliら[15]では、ヒアルロン酸がインプラント経口手術後の創傷治癒を促進することは認められなかったが、これは後期評価時間(手術後10日)、主観的スコアリングシステム、およびサンプル数の少なさと関連している可能性がある。要約すると、インプラント手術後にヒアルロン酸が創傷治癒を促進するかどうかは、さらなる研究によって確認されなければなりません。

4  ヒアルロン酸の薬物送達システムへの応用

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再発性アフタ性潰瘍におけるヒアルロン酸の応用

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.

参照

[1] huang sili, guo xuping, yang guilan, et al。ヒアルロン酸の応用における最近の進歩[j]。2009年(平成21年)10月1日:ダイヤ改正。

[2] 長い X, 陳 G 成ああ et  アル。無作為と いると育っ 裁判 of  上級 and  劣る temporomandibular joint  空間 injection  前の治療におけるヒアルロン酸と ディスク シフト without  か[J]減少する。 J  口頭Maxillofac Surg、 2009年 67(2): 357-361。

[3] Escoda-Francoli J Vzquez-Delgado E Gay-Escoda c .科学的証拠   顎- temporoの管理における関節内ヒアルロン酸注射の有用性 机能の障害にか[J]。 医学 口頭 Patol 口頭 Cirを 2010年Bucal、 15 (4): e644-e648。

[4] li chunjie, zhang yifan, jia yuanyuan, et al。ヒアルロン酸ナトリウムを用いた顎関節機能障害の治療に関する臨床ランダム化比較試験のシステマティックレビュー[j]。西中志志,2011,29(5):488-493。

[5] liu peicai, wang dong, peng cheng, et al。顎関節変形性関節症患者の滑液におけるマトリックス金属プロテアーゼ2および3に対するヒアルロン酸ナトリウムの影響[j]。中国口腔科学研究誌:電子版,2011,5(4):356-360。

[6] zhao jigang, peng guoguang, liang jingzhang, et al。関節洗浄とヒアルロン酸ナトリウム注射による関節軟骨骨折の術後合併症の予防に関する臨床研究[j]。」。journal of modern stomatology(2011): 105-107。

[7] wu yafei, huang jiao, xu yi, et al。plaque-induced gingivitisの治療におけるgengigel gelの役割[j]。日刊実務口腔05シーズンまで、月21日(4):540-542た。

[8] sukumar s, drizhal i .ヒアルロン酸と歯周炎[j]。acta medica (hradec kralove), 2007, 50(4): 225-228。

[9]ウギFrentzen M、JervΦe-Storm P-M。慢性歯周炎の治療におけるヒアルロン酸の役割[j]。^『仙台市史』仙台市史編纂委員会、2004年(平成16年)2月22日、32-34頁。

[10] fawzy el-sayed km, dahaba ma, aboul-ela s, et al。歯周外科手術とヒアルロン酸ゲルの局所適用:ランダム化比較試験[j]。2012年Clin口頭Investig、16(4):1229-1236。

[11] zhang li, chen gang, ma lian, et al。ヒアルロン酸ナトリウムによるインプラント周囲粘膜炎の治療に関する臨床研究[j]。中国口腔インプラント学会誌,2005,10(1):22-24。

[12] mendes rm, silva ga, lima mf, et al。ヒアルロン酸ナトリウムはラットの歯孔の治癒過程を促進する[j]。^ a b c d e f g h『日本の歴史』、2008年(平成20年)、155- 152頁。

【13】曽yunting, tang guohua。薬物が抽出ソケットの治癒に及ぼす影響[j]。oral materials and instruments, 2010, 19(2): 104-107。

[14] lai, h . b ., &liu, y .インプラント手術後の創傷治癒におけるヒアルロン酸ゲルの役割[j]。^『仙台市史』仙台市史編纂委員会、2008年(平成20年)、637-638頁。

[15] galli f, zuffetti f, capelli m, et al。口腔内の外科的切開部の治癒を改善するヒアルロン酸:パイロット多施設プラセボ対照ランダム化臨床試験[j]。 2008年Eur J口頭Implantol、((3))8月1 199-206。

[16] nolan a, baillie c, badminton j, et al。再発性アフタ性潰瘍の管理における局所ヒアルロン酸の有効性[j]。^ a b c d e f g h i j oral pathol med, 2006, 35(8): 461-465。

[17] lee jh, jung jy, bang d .口腔潰瘍再発に対する局所0.2%ヒアルロン酸ゲルの有効性:アフタ潰瘍再発とベーチェルト潰瘍の比較' s病気か[J]。 j eur acad dermatol venereol, 2008, 22(5): 590-595。