Tissue necrosis from hyaluronic acid in dentistry: evaluation of maxillofacial complications and management strategies
Keywords:
ÁCIDO HIALURÓNICO; ESTÉTICA DENTAL; NECROSIS; SEGURIDAD DEL PACIENTE.; HYALURONIC ACID; ESTHETICS, DENTAL; NECROSIS; PATIENT SAFETY.; ÁCIDO HIALURÔNICO; ESTÉTICA DENTÁRIA; NECROSE; SEGURANÇA DO PACIENTE.Abstract
Introduction: hyaluronic acid is widely used in aesthetic dentistry, but it can cause tissue necrosis, a complication that compromises the safety of oral and maxillofacial procedures.
Objective: to review the scientific literature on necrosis associated with the use of hyaluronic acid in rhinoplasty and glabellar filler, identifying risk factors and management strategies.
Methods: a bibliographic review was conducted between 2019 and 2024 in databases such as PubMed, Scielo, and ScienceDirect. Clinical studies and relevant cases in English, Spanish, and Portuguese were included. Exclusion criteria were applied to non-indexed literature and uses other than aesthetic purposes. The analysis compared injection techniques, complications, and treatments.
Development: the reviewed studies report necrosis mainly in the glabella, nasal tip, and lips, associated with accidental vascular occlusion. Early intervention with hyaluronidase is highlighted as an essential treatment, complemented by corticosteroids, antibiotics, and hyperbaric oxygen therapy. The importance of anatomical knowledge and the use of blunt-tip cannulas to reduce risks is emphasized. Although the frequency of necrosis is low, its clinical impact is considerable, requiring standardized protocols and continuous training. The literature also shows variability in the recommended doses of hyaluronidase, reflecting the need for further research to establish clear guidelines.
Conclusions: necrosis caused by hyaluronic acid is an infrequent but serious complication in aesthetic dentistry. Prevention through safe techniques and the immediate availability of hyaluronidase are fundamental. Strengthening professional training and developing evidence-based protocols are recommended to optimize the safety of procedures.
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