The Role of Hyaluronic Acid in Pulp-Dentin Regeneration: A Review of Current Advances

Regenerative Endodontic Procedures (REP) have emerged as a promising approach to treating necrotic immature teeth by promoting tissue regeneration rather than conventional obturation. Hyaluronic acid (HA) has garnered attention for its potential role in endodontic tissue engineering due to its biocompatibility, bioactivity, and ability to modulate cell behaviour. This review explores the application of HA in regenerative endodontics, focusing on its properties, scaffolding potential, and ability to enhance pulp-dentin complex regeneration. HA is a naturally occurring glycosaminoglycan present in the extracellular matrix (ECM), with significant roles in cell proliferation, differentiation, and angiogenesis. These properties make it a suitable candidate for enhancing pulp regeneration, particularly when combined with other biomaterials. Studies have demonstrated that HA-based hydrogels and sponges provide a conducive microenvironment for stem cell adhesion, proliferation, and differentiation, thereby supporting the regeneration of the dentin-pulp complex. Additionally, HA has been shown to have antimicrobial properties and the ability to modulate inflammation, making it particularly useful in preventing bacterial contamination in endodontic treatments. Despite these advantages, challenges remain in optimizing HA-based scaffolds for clinical use. The rapid degradation of HA in physiological conditions necessitates modifications such as crosslinking or combination with other biomaterials to improve its mechanical properties and longevity. Preclinical and clinical studies have investigated the efficacy of HA in regenerative endodontics. In vitro studies indicate that HA enhances odontogenic differentiation of dental pulp stem cells, while in vivo research demonstrates its ability to promote angiogenesis and tissue integration. Clinical applications of HA in endodontics remain limited, and further controlled trials are needed to establish standardized protocols for its use in REP. Future perspectives in the field of HA-based biomaterials in regenerative endodontics include the development of bioactive and multifunctional scaffolds that can provide controlled release of growth factors, enhance cellular responses, and integrate seamlessly with the host tissue. Additionally, optimizing HA formulations for clinical application will require further research on their degradation kinetics, long-term stability, and interaction with other biomaterials. HA represents a promising biomaterial in regenerative endodontics due to its biological properties and potential to improve treatment outcomes. However, further research is needed to refine its applications, improve scaffold formulations, and validate its efficacy through long-term clinical studies.