Cross-linked hyaluronic acid gel with or without a collagen matrix in the treatment of class III furcation defects: A histologic and histomorphometric study in dogs

Abstract

Aim: To histologically evaluate the effects of cross-linked hyaluronic acid (xHyA) with or without a collagen matrix (CM) on periodontal wound healing/regeneration in class III furcation defects in dogs.

Materials and methods: Class III furcation defects were surgically created in the mandibular premolars in six beagle dogs. The defects were randomly treated as follows: open flap debridement (OFD) + CM (CM), OFD + xHyA (xHyA), OFD + xHyA + CM (xHyA/CM) and OFD alone (OFD). At 10 weeks, the animals were euthanized for histological evaluation.

Results: The newly formed bone areas in the xHyA (4.04 ± 1.51 mm² ) and xHyA/CM (4.32 ± 1.14 mm² ) groups were larger than those in the OFD (3.25 ± 0.81 mm² ) and CM (3.31 ± 2.26 mm² ) groups. The xHyA (6.25 ± 1.45 mm) and xHyA/CM (6.40 ± 1.35 mm) groups yielded statistically significantly (p < .05) greater formation of new connective tissue attachment (i.e., new cementum, with inserting connective tissue fibres) compared with the OFD (1.47 ± 0.85 mm) group. No significant differences were observed in any of the histomorphometric parameters between the xHyA and xHyA/CM groups. Complete furcation closure was not observed in any of the four treatment modalities.

Conclusions: Within their limits, the present results suggest that the use of xHyA with or without CM positively influences periodontal wound healing in surgically created, acute-type class III furcation defects.

Keywords: biomaterials; collagen matrix; furcation defect; hyaluronic acid; periodontal wound healing/regeneration.

FIGURE 1

Clinical illustration of the treatment procedure. (a) Prior to reconstructive surgery. (b) Surgically created class III furcation defects. (c) The defects received cross‐linked hyaluronic acid gel (xHyA) with collagen matrix (CM) (xHyA/CM), xHyA and CM (left to right). (d) Flap repositioning and suturing

FIGURE 2

Landmarks/parameters used in histomorphometric analysis. CTA, connective tissue area; CTL, connective tissue adhesion length; DH, defect height; DW, defect width; ETA, epithelial tissue area; JEL, junctional epithelial length; LRS, length of the root surface (TFL + JEL + CTL + NCL); N (N₁, N₂), apical notch; NAL, new connective tissue attachment length; NBA, new bone area; NCL, new cementum formation length; NFA, non‐filled area; TFL, tissue‐free defect length

FIGURE 3

Representative photomicrographs of class III furcation defects in different groups. Open flap debridement (OFD) group. (a) Histologic overview of mandibular right fourth premolar. Collagen matrix (CM) group. (b) Histologic overview of mandibular left third premolar. Cross‐linked hyaluronic acid (xHyA) group. (c) Histologic overview of mandibular left fourth premolar. Cross‐linked hyaluronic acid with collagen matrix (xHyA/CM) group. (d) Histologic overview of mandibular right second premolar (scale bar, 1 mm; haematoxylin and eosin staining). Arrowhead: Notch (apical extension of root planing). NB, new bone

FIGURE 4

Representative photomicrographs of class III furcation defects in different groups. Open flap debridement (OFD) group. (a) Histologic overview of mandibular right second premolar (scale bar, 1 mm; azan staining). Arrowhead: Notch (apical extension of root planing). (b) Higher magnification of the framed area (left) in (a) (scale bar, 200 μm; azan staining). (c) Higher magnification of the framed area (right) in (a) (scale bar, 200 μm; azan staining). Collagen matrix (CM) group. (d) Histologic overview of mandibular right second premolar (scale bar, 1 mm; azan staining). Arrowhead: Notch (apical extension of root planing). (e) Higher magnification of the framed area (left) in (d) (scale bar, 200 μm; azan staining). (f) Higher magnification of the framed area (right) in (d) (scale bar, 200 μm; azan staining). Cross‐linked hyaluronic acid (xHyA) group. (g) Histologic overview of mandibular left second premolar (scale bar, 1 mm; azan staining). (h) Higher magnification of the framed area (left) in g (scale bar, 200 μm; azan staining). (i) Higher magnification of the framed area (right) in (g) (scale bar, 200 μm; azan staining). Cross‐linked hyaluronic acid with collagen matrix (xHyA/CM) group. (j) Histologic overview of mandibular left third premolar (scale bar, 1 mm; azan staining). (k) Higher magnification of the framed area (left) in (j) (scale bar, 200 μm; azan staining). (l) Higher magnification of the framed area (right) in j (scale bar, 200 μm; azan staining). D, root dentin; JE, apical end of junctional epithelium; NB, new bone; NC, new cementum; NPL, new periodontal ligament