Hyaluronic Acid with Bone Substitutes Enhance Angiogenesis In Vivo

Abstract

The effective induction of angiogenesis is directly related to the success of bone-substitute materials (BSM) for maxillofacial osseous regeneration. Therefore, the addition of pro-angiogenic properties to a commercially available bovine bone-substitute material in combination with hyaluronic acid (BSM+) was compared to the same bone-substitute material without hyaluronic acid (BSM) in an in-vivo model. Materials and Methods: BSM+ and BSM were incubated for six days on the chorioallantoic membrane (CAM) of fertilized chicken eggs. Microscopically, the number of vessels and branching points, the vessel area and vessel length were evaluated. Subsequently, the total vessel area and brightness integration were assessed after immunohistochemical staining (H&E, alphaSMA). Results: In the BSM+ group, a significantly higher number of vessels (p < 0.001), branching points (p = 0.001), total vessel area (p < 0.001) as well as vessel length (p = 0.001) were found in comparison to the BSM group without hyaluronic acid. Immunohistochemically, a significantly increased total vessel area (p < 0.001 for H&E, p = 0.037 for alphaSMA) and brightness integration (p = 0.047) for BSM+ in comparison to the native material were seen. Conclusions: The combination of a xenogenic bone-substitute material with hyaluronic acid significantly induced angiogenesis in vivo. This might lead to a faster integration and an improved healing in clinical situations.

Immediate implant placement using xenograft with hyaluronate and collagen fleece

“…This also allows better handling and eliminates any possible granulate sharpness. It is well known that hyaluronate leads to faster cells proliferation and vascularization compared to the xenograft granules alone [6], [7]. The in-vivo degradation of hyaluronate is less than 2 weeks, then allowing the xenograft particles to support osteoconductive bone regeneration [14].…”

Bone gain in alveolar cleft repair combining Hyaluronic acid with anterior iliac crest corticocancellous graft

“…A recent In Vivo study suggested the hyaluronic acid can also increase angiogenesis and bone remodelling as well as healing capacity when used with bone substitutes 22 . Another animal study suggested using hyaluronic acid with tricalcium phosphate particles for calvaria bone defects with similar findings 23 .…”

Socket preservation, sinus lift and lateral augmentation by using natural bovine bone substitute with hyaluronate

“…The bovine derived xenograft granules in combination with hyaluronate provide sticky consistency and better handling at the grafted site. This eliminates any possible granulate sharpness and leads to faster cells proliferation and vascularization compared to the xenograft granules alone [6], [7]. The hyaluronate degrades in 2 weeks and then allows osteoconductive bone regeneration by the xenograft particles alone [13].…”

“…However, these post-extraction sites require grafting materials that support volume stability [5]. Bovine derived xenograft granules in combination with hyaluronate have been created to achieve faster cells proliferation, vascularization, and better clinical outcomes [6]- [8]. Also, the use of long-term Guided Bone Regeneration (GBR) barrier membrane is of crucial importance to prevent the faster proliferating soft tissue into the grafted area [9].…”