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58 rev port estomatol med dent cir maxilofac. 2020;61(2):57-63

O papel do ácido hialurónico no tratamento não cirúrgico
da periodontite crónica – Revisão sistemática

r e s u m o

Palavras-chave: Objetivos: O objetivo desta revisão foi realizar uma análise sistemática que avalie os efeitos
Ácido hialurónico clínicos e microbiológicos do uso local subgengival de HA 0,8% ou 0,2% como adjuvante ao
Periodontite alisamento radicular em pacientes com periodontite crónica.
Alisamento Métodos: Foi realizada uma pesquisa eletrónica nas seguintes bases de dados: PubMed,
Tratamento da periodontite Lilacs e Chocrane sem restrições de tempo ou idioma, até 9 de Maio de 2018. Foram utili-
zadas as seguintes palavra-chave (“ácido hialurónico”; “periodontite”; “tratamento da
periodontite”; “alisamento radicular”). Os seguintes parâmetros clínicos foram avaliados,
nível de inserção clínica, profundidade de sondagem, hemorragia à sondagem, índice de
placa e índice gengival. A revisão foi registrada com o número de identificação
CRD42019131541, no PROSPERO International Prospective Register of Sistemmatic Revie-
ws, hospedado pelo Instituto Nacional de Pesquisa em Saúde, Universidade de York, Cen-
tro de Revisões e Disseminação.
Resultados: A combinação da aplicação ácido hialurónico com o alisamento radicular, apre-
senta resultados clínicos mais satisfatórios, quando comparados com o alisamento radicu-
lar isolado.
Conclusões: Pode-se concluir que o ácido hialurónico é um adjuvante químico a considerar
na terapia periodontal. (Rev Port Estomatol Med Dent Cir Maxilofac. 2020;61(2):57-63)
© 2020 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

non-toxic, biocompatible, and has numerous biochemical and
Introduction
physio-chemical features, its topical and systemic application
Periodontitis is a multifactorial infection that results in con- benefits the host response regulation. 4
nective tissue destruction, alveolar bone resorption, and, HA has already been used in the treatment of inflamma-
1
eventually, tooth loss. Periodontal disease is one of the most tory processes in various domains, such as orthopedics, der-
prevalent chronic inflammatory diseases worldwide. Non-sur- matology, and ophthalmology. In dentistry, it has been used in
gical treatment has been effective in most cases, but it has temporomandibular joint disorders, and more recently in the
1
some limitations. Recently, an adjuvant for periodontal treatment of periodontal disease thanks to its anti-inflamma-
treatment that could improve periodontal healing has been tory, anti-edematous and anti-bacterial effects. 5
studied. A wide range of chemotherapeutic agents, chlorhex- HA has two essential functions: play a structural role, due
idine and, more recently, hyaluronic acid (HA) have stood to being a constituent of the tissues’ architecture that increas-
out. 2 es the volume of the extracellular matrix (ECM) by filling it with
HA is one of the main components of the matrix of the water and ions; and regulate cell signalization, as it interacts
periodontal ligament. It assumes a multifunctional role in with constituents of the ECM and with membrane receptors.
6
wound healing, has a great anti-inflammatory capacity, and HA can directly prevent the proliferation and colonization of
3
plays a role in adhesion, reproduction and cell proliferation. periodontal pathogens and indirectly moderate inflammation
Its topical application has recently been used as an adjuvant and stabilize the granulation tissue by preventing degradation
treatment for chronic inflammatory diseases. Different local of the extracellular matrix proteins by serine proteinases de-
3
antimicrobial and anti-inflammatory adjuncts have been rived from inflammatory cells as healing progresses. 5
shown to improve the outcome of scaling and root planning Indeed, preliminary clinical trials have shown that HA has
(SRP). anti-inflammatory, anti-edematous, and anti-bacterial effects
Chemical agents are widely used to treat oral diseases, and for the treatment of gingivitis and periodontitis. It plays an
various antibiotics and anti-inflammatory agents have been anti-inflammatory role by inhibiting tissue destruction and
3
trailed in previous studies. However, recent initiatives have facilitates healing by reducing prostaglandins, metalloprotein-
started to use chemotherapeutic agents to treat periodontal ases, and other bioactive molecules. 7
diseases, and HA is a recent addition to those. HA has been The purpose of this systematic review was to evaluate the
3
used as an exogenous agent in the treatment of chronic in- clinical effects of local subgingival use of 0.8% or 0.2% HA
flammatory changes due to its role in the control of inflam- when adjunct to SRP in patients with chronic periodontitis
mation and tissue regeneration mechanisms. Since HA is (CP).