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

Background Periodontitis is a prevalent disease characterized by the formation of challenging osseous defects. Periodontal regeneration of these defects is notoriously difficult to achieve, given the complexity of the periodontal apparatus. The aim of this 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. Materials and Methods A composite hydrogel scaffold composed of hyaluronic acid, chitosan and polyvinyl alcohol was successfully prepared and characterized. Thirty-two critical size class II furcation defects were created in eight mongrel dogs. Defects were randomly allocated to group I, hydrogel group and group II, negative control group. Histological and histomorphometric analysis were used to evaluate the regenerative potential of the novel hydrogel after one and three months, postoperatively. Results 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 is cytocompatible, has proper degradation rate, water uptake and mechanical strength as well as ease of handling clinically. The hydrogel showed promising periodontal regenerative potentials in furcation defects in dogs as it led to new bone formation and inhibited the downgrowth of epithelium. Finally, to achieve the desirable outcomes obtained by this hydrogel, the best HA/CS w/w ratio is 3/3.