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CONTENTS
II
Hyaluronic acid:
natural wound healing
Hyaluronic acid:
supporting tissue retention
tissue regeneration
IV HYADENT products
V-2 in GTR/GBR
V-3 in sinus elevation
V-4 ridge/socket preservation
in
V-5 open healing of an implant
in
VI HYADENT: use in
periodontal therapy
and indications
VII HYADENT in
esthetic reconstruction
VIII HYADENT as a
preventive treatment
V-1 in apicoectomy
IX
Benefits of HYADENT
1: Homeostasis
Following injury, platelets aggregated to form a fibrin clot for primary wound closure.
2: Inflammatory phase
Inflammation and exudation are the key features of this phase. Macrophages and neutrophils
migrate into the fibrin plug. This is followed by the production of inflammatory cytokines and
growth factors. These in turn stimulate migration of fibroblasts into the wound area. Hyaluronic
acid promotes and at the same time regulates the inflammatory process, as it has an antioxidative effect and reduces the activity of pro-inflammatory proteases, thus allowing a stable
matrix to be formed. This mechanism is disrupted in chronic wounds, so that inflammation
persists and wound healing is disrupted. Formation of pro-inflammatory cytokines (TNF-alpha,
IL-1 beta, and IL-8) is inhibited. Hyaluronic acid has an anti-oxidative effect and reduces the
activity of pro-inflammatory proteases.
3: Proliferative phase
The granulation tissue, which is rich in hyaluronic acid, forms a hydrated matrix which facilitates
receptor-mediated (CD44) cellular migration. Cell mitosis, cell proliferation, and angiogenesis
are supported by low molecular weight hyaluronic acid polymers. Granulation tissue largely
consists of fibroblasts which have migrated into the tissue, newly formed capillaries, collagen,
fibronectin, and hyaluronic acid. High concentrations of hyaluronic acid are found in the basal
layers of the epidermis. This encourages the proliferation and migration of basal keratinocytes (via the CD44 cell surface receptor). Regulation of keratinocyte proliferation also occurs.
Epithelialization is both stimulated and regulated.
HYALURONIC ACID:
supporting tissue retention
Hyaluronic acid is a natural polysaccharide and a
member of the glycosaminoglycan family. The
molecule consists of a repeating sequence of a
disaccharide composed of D-glucuronic acid and
N-acetylglucosamine.
Most somatic cells, especially connective tissue
cells, are able to produce hyaluronic acid. It is formed at the cell membrane and excreted directly into
the extracellular matrix.
Hyaluronic acid is a major component of the extracellular matrix in almost all tissues. As such, its primary role is to bind water to permit the transportation of key metabolites and maintain tissue structure.
Hyaluronic acid activates metalloproteinase inhibitors, thus suppressing tissue breakdown. A similar
effect is produced by the inhibition of inflammatory
cytokines (e.g. TNF). Hyaluronic acid can thus visibly
contribute to tissue retention.
4: Remodeling phase
Shrinkage reduces the wound size and accelerates healing. Scar tissue consists of collagen,
elastic fibers, and proteoglycans. Hyaluronic acid plays an important role in regulating scar
formation. In the final phase of wound healing scar formation hyaluronic acid is responsible
for ensuring that suppression of collagen production occurs at the right time and for soft scar
formation. In the fetal period, for example, the concentration of hyaluronic acid in wounds is
very high for a prolonged period, as a result of which wound healing always occurs without
scar formation.
II
We have now found a way of utilizing the mechanism of action of hyaluronic acid in dental surgery and have developed
two entirely novel products:
Effect:
peeds up wound healing
S
after surgical procedures
Effect:
hields the wound area from penetration
S
of bacteria and connective tissue
Papilla reconstruction
Resorption period:
16 21 days
Resorption period:
6 11 hours
III
IV
USE IN APICOECTOMY
1
1 Partsch incision
2 Flap mobilization to expose the affected area
3 Exposure of the root tip
4 Curettage of the granulation tissue
5 Filling the bone defect with bone regeneration
material and HYADENT
6 Covering the wound area with HYADENT barrier gel
6
1)
V-1
1 Extraoral enrichment
of the granules
2 Granules ready to use
2) Sasaki
1)
V-2
Weigel PH, Fuller GM, LeBoeuf 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 119, 219-234 (1986)
T, Watanabe C: Stimulation of osteoinduction in bone wound healing by high-molecular hyaluronic acid. Bone 16, 9-15 (1995)
Schwartz Z, Goldstein M, Raviv E, Hirsch A, Ranly DM, Boyan BD: Clinical evaluation of demineralized bone allograft in a hyaluronic acid carrier for sinus lift
augmentation in humans: a computed tomography and histomorphometric study. Clin Oral Implants Res 18, 204.211 (2007)
3) Source:
Dental Clinics, Journal Of General Dentistry, Hyaluronic acid: biological effects and clinical applications Demarosi F, Sardella A, Lodi G, Carrassi A.
V-3
V-4
V-4
The following example illustrates how using HYADENT barrier gel can optimize soft tissue management in open post-implantation healing (with no
surgical suture). Open healing of a dental implant
in the front teeth area is a strong case for an ideal,
natural looking esthetic. Unfortunately, this treatment
option is frequently undermined by a failure to meet
patient-related requirements.
10
11
12
1 Initial situation
7 3 months post-implantation
V-5
12 Final state
V-5
2)
VI
1) Jentsch H, Pomowski R, Kundt G, Gocke R: Treatment of gingivitis with hyaluronan. J Clin Periodontol 30, 159-164 (2003)
Pirnazar P, Wolinsky L, Nachnani S, Haake S, Pilloni A, Bernard GW: Bacteriostatic effects of hyaluronic acid. J Priodontol 70, 370-374 (1999)
Galgut P: The role of hyaluronic acid in managing inflammation in periodontal diseases, Dental Health 42, 3-6
3) van den Bogaerde L, MD, DDS: Behandlung von intraossren Parodontaldefekten mit veresterter Hyaluronsure:
Klinischer Bericht ber 19 nacheinander behandelte Lsionen. Int J Paro & Rest ZHK, 29 3, 299-307 (2009)
1 Initial situation
2 Approx. 3 weeks after the
second injection
VII
Bleaching / Whitening
Most bleaching gels contain hydrogen peroxide or carbamide peroxide
(the modes of action of which are almost identical). As well as the desired effect of bleaching the teeth, both substances can also frequently
exert unwanted effects on the mucosal tissue surrounding the teeth.
Despite the care taken and protective measures employed by the
dentist, irritation of the mucosa is very common. Recent clinical results
call for a reevaluation of this procedure.
In addition to the DGZMKs 2001 statement, a notable review has been
published (Hasson et al., Cochrane Database Syst Rev 2006) which
takes a systematic look at available publications and calls for a critical
reevaluation of our current knowledge. The review found that 45.9% of
8143 participating dentists evaluated mucosal irritation as a side effect
of tooth whitening treatments. An EU recommendation on hydrogen
peroxide-based bleaches and oral hygiene products (Dec. 2007) gives
added urgency to the need to reevaluate this treatment.
Continued overleaf
1 Bleaching splint
2 Bleaching splint (cross section)
3 Tissue care splint
4 Tissue care splint (cross section)
VIII
VIII
TREATMENT PROCEDURE
1
VIII
VIII
OVERVIEW OF USAGE
HYADENT
HYADENT
barrier gel
USAGE
USAGE
REFERENCES:
Benefits of HYADENT
USE IN IMPLANTOLOGY
Reducing scar formation in esthetically demanding
areas by reducing collagen deposition
Socket Preservation
DOSAGE FORM
HYADENT
PRODUCT TYPE
PRODUCT
Singleuse syringe /
direct application option
Singleuse syringe /
direct application option
PACKAGING
Sterile blister
Sterile blister
UNIT VOLUME
1 x 1 ml
1 x 1 ml
APPLICATION
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IX
EXCLUSIVE DISTRIBUTORS
Naturelize GmbH
www.naturelize.com
customer.service@naturelize.com
Japan:
Asia-Pacific Region:
MANUFACTURER
BioScience GmbH
Rheinstrae 96
56235 Ransbach-Baumbach | Germany
www.bio-science.org
info@bio-science.org