Furcation defects are often difficult to access for effective professional debridement because their narrow entrances prevent periodontal instruments from reaching them. Additionally, the ridges, convexities, and concavities within the defect make instrumentation challenging, so regenerating the periodontium in these areas is considered one of the most difficult tasks in periodontal therapy. ¹ Despite anatomical challenges, studies have shown that Grade II furcation defects can achieve reduced probing depths and improved clinical attachment levels (CAL) through the use of coronally positioned flaps, hard tissue grafts, and guided tissue regeneration, with or without the addition of various grafting materials. ² Xenograft is a type of graft derived from a different species, such as bovine, equine, or coral. It is a demineralized bone matrix derived from decalcified animal sources, such as bovine or equine, resulting in nonimmunogenic particles, typically around 250 µm in size. These particles are gradually resorbed and replaced by the host bone within approximately 24 weeks.

Recently, clinicians have begun using a combination of grafting materials and extracellular matrix (ECM) components to promote periodontal regeneration. Hyaluronan/Hyaluronic Acid (HA), a natural ECM component, plays a crucial role in the functioning of extracellular matrices, including those in the periodontium. Therefore, the objective of this case report was to assess the effect of combining HA with a xenograft in the treatment of a Grade II furcation defect.

A 56-year-old male patient reported to the Department of Periodontology and Implantology, Coorg institute of dental science, virajpet with the chief complaint of bleeding gums. The patient was physically healthy with no known medical conditions. An intraoral examination revealed soft, edematous gingiva throughout the oral cavity, with bleeding on probing observed in over 60% of the sites. Probing depths of 8 mm and a Grade II furcation defect were noted for tooth #46, indicating significant periodontal involvement [Figure 1 a and b].

Phase 1 therapy began after the treatment plan was explained to the patient and informed consent was obtained. The patient was advised to use a 0.12% chlorhexidine gluconate mouthwash twice a day for 14 days. Following this period, the patient was evaluated. After the administration of local anesthesia, a crevicular incision was made with a #12 blade, and the mucoperiosteal flap was reflected to allow for thorough debridement of the furcation defect [Figure 2]. A xenograft (Osseograft) with high molecular weight HA (Gengigel) was then condensed into the furcation and intrabony defects associated with teeth #46 and #47 [Figure 3 a and b]. The flap was repositioned and secured with 3-0 silk sutures, after which Coe-Pack was applied to the surgical site [Figure 4 a and b].

In conclusion, the combination of xenograft and HA for treating Grade II furcation defects appears to be a promising and effective approach. The combined use of HA and a bone graft in treating Grade II furcation defects led to improved clinical outcomes and radiographic evidence of bone regeneration. The anti-inflammatory, bacteriostatic, and osteo-inductive properties of HA contributed significantly to the observed improvements. However, to reinforce these findings, additional studies with larger sample sizes are needed. This case report supports the potential of HA as an adjunctive treatment in periodontal therapy for furcation involvement.