Hyaluronic Acid as a Therapeutic Adjunct in Impacted Mandibular Third Molar Surgery: Biological and Clinical Insights – A Narrative Review

Surgical extraction of impacted mandibular third molars is commonly associated with postoperative complications such as pain, swelling, trismus, delayed wound healing and alveolar osteitis. Hyaluronic acid (HA), a naturally occurring glycosaminoglycan, has gained attention for its potential to mitigate these complications and promote tissue healing. This narrative review summarizes current evidence on the biological properties and clinical applications of HA in third molar surgery. Relevant clinical and experimental studies evaluating its effects on postoperative pain, swelling, trismus, soft-tissue healing and bone regeneration were reviewed. HA demonstrates biocompatibility, biodegradability, viscoelasticity and anti-inflammatory activity. Evidence suggests it reduces pain and trismus by inhibiting inflammatory mediators and promoting antioxidant effects. It enhances soft-tissue healing through angiogenesis and fibroblast activation and supports bone regeneration. Topical HA has shown efficacy comparable to corticosteroids and NSAIDs, with fewer systemic effects. When combined with minimally invasive surgical techniques, HA further improves healing and patient comfort. HA is a promising adjunct for enhancing postoperative recovery in impacted mandibular third molar surgery. Further well-designed randomized controlled trials are needed to standardize its concentration, formulation and application protocols for optimal clinical use.