A novel composite hyaluronic acid/chitosan/polyvinyl alcohol ternary hydrogel scaffold for periodontal regeneration: an experimental study

BACKGROUND: Furcation defects are considered among the most challenging periodontal lesions to regenerate given the complexity of the periodontal apparatus, inaccessibility and the limited blood supply to the area. The aim of the current study was to create and characterize a novel ternary hydrogel composed of hyaluronic acid (HA), chitosan (CS) and polyvinyl alcohol (PVA) and to evaluate its potentials in periodontal regeneration of furcation defects in dogs. MATERIALS AND METHODS: A composite hydrogel scaffold composed of hyaluronic acid, chitosan and polyvinyl alcohol was successfully prepared and characterized in terms of SEM, swelling and mechanical behaviors, FTIR analysis as well as biocompatibility assay and direct cell-scaffold interactions. In an in vivo study, thirty-two critical size class II furcation defects were created in eight mongrel dogs and randomly allocated to group I, hydrogel group and group II, negative control group. Histological analysis and histomorphometric evaluation of percentage of newly formed bone area were used to evaluate the regenerative potential of the novel hydrogel after one and three months, postoperatively. RESULTS: The prepared hydrogel was cytocompatible, had proper degradation rate, water uptake and mechanical strength as well as ease of handling clinically. Histologic results of the hydrogel group revealed superior bone, periodontal ligament and cementum formation compared to the negative control group at both time points. The hydrogel group showed a statistically significant increase in the percentage of newly formed bone surface area compared to the negative control group. CONCLUSIONS: The novel ternary hydrogel prepared using hyaluronic acid, chitosan and polyvinyl alcohol showed adequate cytocompatibility and mechanical properties. The in vivo results support that the novel scaffold might be effective for periodontal regeneration in furcation defects in dogs.