Pilloni Andrea, Annibali Susanna, Dominici Francesco, Di Paolo Carlo, Papa Marco, Cassini Maria Antonietta, Polimeni Antonella
Department of Oral and Maxillofacial Sciences, Periodontics Unit, "Sapienza" University of Rome, Rome, Italy.
Ann Stomatol (Roma). 2011 Mar;2(3-4):3-9. Epub 2012 Jan 27.
Hyaluronic acid (HA) is an ubiquitous form of non-sulphated glycosaminoglycan of the extracellular matrix of all mammalian connective tissues. It is mainly present during tissue's formation or during most of initial tissue's repair processess. Cell migration, adhesion and differentiation are only part of several unique biological characteristics of HA which have been under investigation in the past decades.
Evaluate the possible positive effect of an esterified form of HA on gingival tissues in mild chronic periodontitis patients, seeking for the reduction of all the periodontal disease clinical parameters PLI (Plaque Index), BOP (Bleeding on Probing), PPD (Probing Pocket Depth), GI (Gingival Index), PAL (Probing Attachment Level).
The study is an open, intra-patient, controlled, single center pilot clinical trial including 19 adult patients with mild chronic periodontitis and shallow pockets (< 4 mm) in at least two different quadrants. One quadrant was treated with HA gel after regular toothbrushing (test), the other without (control).
Although oral hygiene itself had a similar positive influence on the improvement of all the clinical indexes for test and control, the treatment with HA gel showed a greater effect almost always statistically significant. BOP in the HA gel treated areas had a decrease of 92.7% and GI of 96.5%, whereas controls 75.8% and 79.0% respectively. The difference of PPD in both areas was statistically significant (p<0.01) in favour of the HA gel treated zone. Also PAL and Pl were reduced more with gel than with oral hygiene alone, although this did not reach a statistical significant difference.
It appears that an esterified gel form of HA has shown an effect in reducing the gingival inflammation when used as an adjunct to mechanical home plaque control and that it could be successfully used to improve the periodontal clinical indexes. This pilot study will gain substantial scientific significance when both a higher number of patients can be utilized and also by adding any possible further biological information, as with immunocytochemistry and histology.
透明质酸（HA）是所有哺乳动物结缔组织细胞外基质中一种普遍存在的非硫酸化糖胺聚糖形式。它主要存在于组织形成过程中或大部分初始组织修复过程中。细胞迁移、黏附和分化只是过去几十年来一直在研究的HA几种独特生物学特性的一部分。
评估HA的一种酯化形式对轻度慢性牙周炎患者牙龈组织可能产生的积极影响，寻求降低所有牙周疾病临床参数，即菌斑指数（PLI）、探诊出血（BOP）、探诊袋深度（PPD）、牙龈指数（GI）、探诊附着水平（PAL）。
该研究是一项开放性、患者自身对照、单中心的试点临床试验，纳入了19名成年轻度慢性牙周炎患者，且至少两个不同象限有浅袋（<4mm）。一个象限在常规刷牙后用HA凝胶治疗（试验组），另一个象限不使用（对照组）。
尽管口腔卫生本身对试验组和对照组所有临床指标的改善都有类似的积极影响，但用HA凝胶治疗几乎总是显示出更大的效果，且在统计学上具有显著意义。HA凝胶治疗区域的BOP降低了92.7%，GI降低了96.5%，而对照组分别为75.8%和79.0%。两个区域PPD的差异在统计学上具有显著意义（p<0.01），有利于HA凝胶治疗区。此外，与单独口腔卫生相比，凝胶治疗使PAL和Pl的降低幅度更大，尽管这未达到统计学显著差异。
似乎HA的酯化凝胶形式在作为家庭机械性菌斑控制的辅助手段使用时，已显示出减轻牙龈炎症的作用，并且可以成功用于改善牙周临床指标。当能够纳入更多患者并添加任何可能的进一步生物学信息，如免疫细胞化学和组织学信息时，这项试点研究将具有重大的科学意义。
