Radiographic Evaluation of Defect Fill in Grade II Furcation Employing Guided Tissue Regeneration with Xenograft Alone and Mineral Trioxide Aggregate Combined with Xenograft. Randomized Control Trial

ABSTRACT

Introduction:

Guided tissue regeneration using bone grafts and barrier membranes has shown success, but newer materials like mineral trioxide aggregate (MTA) may enhance outcomes.

Materials and Methods:

20 patients of Grade II furcation involvement. Randomization 10 patients included in group A xenograft layered with MTA and 10 sites were treated with xenograft followed by membrane placement with follow-up of three and six month.

Results:

Group B with MTA was slightly superior with regard to the outcome being observed (P < 0.05).

Conclusion:

Placing of layer of MTA with xenograft in Grade II furcation defect showed similar result with guided tissue regeneration with xenograft, which is cost-effective.

INTRODUCTION

The treatment of bone defects using biomaterials has been extensively studied in the dental field.[1] Since the pioneering work by Urist, who demonstrated heterotrophic formation of bone induced by devitalized demineralized bone matrix, a new possibility of treating bone defects was established.[2] Demineralized bone matrix has osteoinductive properties due to the presence of soluble growth factors on its composition.[3,4] Mineral trioxide aggregate (MTA), a calcium silicate-based cement, has emerged as a promising biomaterial due to its exceptional biocompatibility, bioactivity (promoting cementogenesis and osteogenesis), sealing ability, and antimicrobial properties.[4] Originally developed for endodontic applications, MTA’s ability to stimulate hard tissue formation and support cell adhesion has spurred interest in its potential for periodontal regeneration.[5] Concurrently, studies continue to investigate the optimal use of MTA in complex surgical scenarios like apical surgery, often involving significant bone loss.[6]

Aim

The current study aimed to compare the surgical outcome of Grade II furcation therapy with xenograft alone, xenograft along with MTA.

MATERIALS AND METHODS

Inclusion criteria

Patients within the age group of 35–55 years with bilateral Grade II furcation involvement in first and second mandibular molars and with radiographic evidence of inter-radicular bone loss were selected.

Exclusion criteria

Patients with systemic diseases contraindicating periodontal therapy, patients showing unacceptable oral hygiene, and periodontal surgery within the last 12 months were excluded.

A randomized controlled trial was conducted on 20 patients with Grade II mandibular furcation defects, divided into two groups: Group A (MTA + Xenograft): Defects filled with MTA mixed with xenograft (bovine-derived hydroxyapatite) and covered with a resorbable membrane included 10 patients. Group B (Xenograft alone): Defects filled with xenograft alone and covered with a resorbable membrane included 10 patients. Radiographic analysis and standardized radiographs using direct digital radiography were taken to assess the bone fill. The radiographs are then imported to CorelDraw to measure the defect depth. Clinical specifications, including “plaque index (PI),” “probing depth,” clinical attachment loss, were approximated at baseline and six months postoperatively.

Surgical therapy

The surgical sites were anesthetized following appropriate isolation of the surgical field. Sulcular incisions were given and the muco-periosteal flap was raised. Furcation defects were debrided thoroughly. Grade II furcation defects were only further included in the study. In control group xenograft with collagen membrane placed as shown in Figures 1 and 2. Radiographic analysis after treatment was performed at baseline, three-month, and six-month follow-up postoperatively [Figures 3 and 4].

Figure 1.

(a) Full thickness flap reflected with xenograft placement (b) colllagen membrane placed (c) post operative

Figure 2.

(a) Added layer od MTA over bone graft (b) collagen membrane palcement (c) suturing

Figure 3.

(a) At baseline (b) At 3-month follow-up (c) At 6-month follow-up

Figure 4.

(a) At baseline (b) At 3-month follow-up (c) At 6-month follow-up

RESULTS

Data was entered in Microsoft excel. Data normality was explored using Kolmogorov–Smirnov and Shapiro–Wilk tests suggesting P > 0.05. All the data analysis was performed using IBM SPSS software 25.0. Study was conducted for six month and clinical parameters were evakuated by single observer. Furcation defect fill calculated with help of radiovisiography defect fill was measured from crest of defect toward the root Furca. MTA and xenograft showed significant reduction at baseline first month and at six-month follow-up [Table 1 and Graph 1]. But on the intragroup comparison, there is not any significant difference found as per study. Both intragroup and intergroup comparison showed no any significant difference. The intergroup comparison for reduction in probing pocket depth (PPD) between group A and group B. It was observed that although a significant mean reduction in PPD was observed in both groups individually, there was no any significant difference (P < 0.05). It was observed that although a significant mean reduction in PI was observed in both groups individually, group comparison did reveal slightly significant overall reduction with group A (P < 0.05).

Table 1.

The intragroup and intergroup comparison of defect fill

Follow-up duration	Defect fill
	Xenograft	Xenograft + MTA	P
Baseline	1.61±0.71	1.60±0.44	>0.05
1 month	0.37±0.13	0.46±0.17	<0.05*
6 months	0.21±0.12	0.36±0.14	<0.05*
P	<0.05*	<0.05*

*Significant P<0.05, NS=Nonsignificant. MTA=Mineral trioxide aggregate

Graph 1.

Intergroup comparison for probing pocket depth

DISCUSSION

MTA is recognized for its excellent biocompatibility and ability to promote pulp tissue regeneration; MTA creates scaffolds with controlled macropore sizes and structures.[7] The MTA hybrid scaffolds demonstrated significant biological performance, promoting the adhesion, proliferation, and differentiation.[8] The scaffolds exhibited a compressive strength of 4.5 MPa and high porosity (70%), which are favorable for mechanical stability and biological activity.[8] Fakheran et al. al studied MTA layered over BetaTCP alloplastic bone graft as a retrograde fill material for furcation involvement was performed in animal-based study.[8] This long-term success highlights the potential of MTA and GTR in achieving positive clinical outcomes in apical surgery. Pinheiro et al. 2011 studied MTA mix with bone graft for GTR.[2] Chiu et al., 2017 studied characteristics of MTA/polycaprolactone three-dimensional scaffold with osteogenesis properties for tissue regeneration.[6] Results indicate that MTA/PCL hybrid scaffolds possess promising characteristics for dental and bone tissue regeneration.

Limitation

A longer follow-up (≥12 months) is essential to assess stability, standardized bone fill content. CBCT should be used in this study.

CONCLUSION

It aligns with the current research focus of combining MTA with other materials to enhance regeneration. Xenograft with a layer of MTA showed a slightly significant defect fill as compared to xenograft alone in treating Grade II furcation defects.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.