Histologic evaluation of furcation perforation treated using bioceramic putty with and without platelet rich fibrin or chitosan hydrogel as an internal matrix

The present study investigated the tissue reaction of platelet rich fibrin and chitosan hydrogel as internal matrices in repairing furcal perforations in mature dogs' teeth. Seventy-two teeth in six mongrel dogs were experimented in this study. After access opening, root canal preparation was completed and obturation was done using gutta percha/resin sealer. Furcation perforations were done, and the experimental teeth were classified according to the perforation repair protocol to three experimental groups and a positive control group (18 teeth each). Group 1: Platelet-rich fibrin matrix with premixed calcium silicate-based bioceramic putty (BC putty), Group 2: Chitosan hydrogel matrix with BC putty, Group 3: BC putty alone and Group 4: a positive control group where no repair material was utilized. Access openings were restored with composite filling. The experimented teeth and the supporting bone were sectioned into blocks and histologically examined for tissue reaction at one and three months. Statistical analysis was performed using Chi-square test, where the significance level was set at P ≤ 0.05. BC putty and BC putty with PRF matrix exhibited less bone loss, epithelial proliferation and inflammatory reaction compared to chitosan hydrogel at one and three months intervals, also they showed more hard tissue deposition compared to chitosan hydrogel at 3-month interval. Although BC putty presented higher sealing ability with great area of newly formed hard tissue compared to chitosan hydrogel, BC putty with PRF can be considered as a successful management option for furcal perforation repair. Management of perforation is considered a challenging procedure especially when located in the furcation area, however histological evaluation of the tissue reaction to different internal matrices materials could provide favorable clinical outcomes concerning the perforation repair procedures.