A clinical evaluation of hydroxyapatite cement in the treatment of Class III furcation defects

Calcium hydroxyapatite cement (HAC) has been demonstrated in both animal models and human craniofacial defects to be safe, absorbable, osteoconductive, and possibly osteoinductive. This pilot study evaluated a novel technique using HAC to surgically obturate Class III mandibular molar furcation defects.

Following flap reflection, affected teeth in 6 patients were root planed and etched with citric acid. Experimental sites were grafted with HAC and coronally positioned flaps (CPF), while controls were treated by CPF only. A variety of clinical parameters were recorded initially, and at re-entry surgery 9 months later.

At re-entry, all experimental sites exhibited granulation tissue interposed between the HAC and the alveolar bone, and clinical findings were unsatisfactory. Mean probing depth, clinical attachment loss, and recession increased by 0.8 mm, 1.9 mm, and 1.2 mm, respectively, in experimental sites. In controls, mean probing depth decreased by 0.8 mm, and clinical attachment loss and recession increased by 0.3 mm and 1.2 mm, respectively. There was a mean 1.6 mm loss in osseous crest height and a mean 2.2 mm worsening in osseous defect depth for experimental sites, but only a 0.5 mm loss in osseous crest and 0.5 mm increase in osseous defect depth in control sites.

Experimental sites lost 1.0 to 1.5 mm in bone and attachment compared to controls, without any significant clinical benefit. While the concept of surgically obturating Class III furcation defects with a safe, osteoconductive material remains attractive, HAC did not promote repair or regeneration in this technique.