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Objectives: The present study aimed to evaluate the effect of ; 1combined demineralized freez dried bone allograft( DFDBA)plus hyaluronic acid(HA) compared to DFDBA alone, and 2) combined DFDBA/HA compared to DFDBA /PRP in treatment of periodontal infrabony defects(PIDs). Subjects and methods:45 infrabony defects in subjects with chronic periodontitis were randomly divided into 3 groups treated with, group 1: DFDBA/HA, group 2: DFDBA/PRP and group 3: DFDBA alone. Clinical and radiographic measurements were made at baseline and 12 months after surgery. ANOVA followed by Tukey’s post hoc test were used to analyze the data. Results: A statistically significant improvement in clinical attachment level( Cal) and pocket depth ( PD) as well as radiographic bone fill were reported in group 1 and 2 compared to DFDBA alone( p ≤ 0.05), a non significant difference was reported between group 1 and group 2 regarding clinical and radiographic parameters(p > 0.05). Conclusion : Results of the present investigation suggests that the combination of DFDBA/HA is more effective both clinically and radiographically than DFDBA alone in treatment of PIDs and that both HA and PRP combined with DFDBA are equally effective in treatment of these defects. (1468) Naglaa M. El-Wakeel E.D.J. Vol. 63, No. 2 Demineralized freeze-dried bone allograft, has been used alone and in combination with other treatment modalities for periodontal therapy owing to its osteoconductive and osteoinductive potential (3,4). The observations from histological and clinical studies have shown that some of the grafting procedures may result in healing that can be defined as “periodontal regeneration.” However, complete and predictable reconstruction of periodontal tissues is still difficult to obtain (5). Critical clinical components for PIDs successful outcomes are: 1Wound stability during the early healing sequence, 2Space provision to allow the migration and proliferation of cells from the PDL and alveolar bone and 3conditions favoring primary intention healing(6). The healing of periodontal surgery wound is complicated, as different cells and growth factors are involved in the healing process(7). Studies on wound healing have shown that, after surgery, platelets participate in clot formation and release a series of growth factors involved in cell division and differentiation. Consequently in the repair and tissue forming, therefore, these growth factors can be used to enhance tissue healing process(8). Platelet-rich plasma is a volume of plasma fraction of autologous blood having platelet concentrations above baseline. As being rich in growth factors that play an essential role in tissue healing-such as transforming growth factor-β, vascular endothelial growth factor, and platelet-derived growth factor, PRP is used in various surgical fields to enhance bone and soft-tissue healing by placing supra physiological concentrations of autologous platelets at the site of tissue damage, favorable periodontal regenerative outcomes was reported to be enhanced by the combined use of PRP with bone allografts( 9,10). Hyaluronic acid (HA) is a naturally occurring linear polysaccharide of the extracellular matrix of connective tissue, synovial fluid, and other tissues that possesses various physiological and structural functions. In the field of dentistry, preliminary clinical trials have been conducted by. Pagnacco e al.(11) in 1997. Hyaluronate has shown anti-inflammatory, anti-edematous and anti-bacterial effects for the treatment of gingivitis and periodontitis(12). Due to its acceleration in periodontal tissue healing properties, it was used as an adjunct to mechanical therapy(13), HA administration to periodontal wound sites could achieve comparable beneficial effects in periodontal tissue regeneration and periodontal disease treatment(14),further, Hakansson et al. suggested a role of HA in migration and adherence of polymorphonuclear leukocytes and macrophages at the inflamed site and the phagocytosis and killing of invading microbes. Such events would allow counteraction of colonization and proliferation of anaerobic pathogenic bacteria in the periodontal tissues(15 ).HA was reported to accelerate bone regeneration by chemotaxis , proliferation and successive differentiation of mesenchymal cells. HA has been reported to share bone induction characteristics with osteogenic substances such as bone morphogenetic proteins and osteopontin (16). The effectiveness of PRP in combination with different types of grafting materials (with or without GTR) has been evaluated in regenerative periodontal therapy and mostly PRP is combined with bone grafts in the treatment of intrabony defects, since the space maintenance of the defect is a crucial factor in periodontal regeneration(17,18). Several previous reports have evaluated the clinical and radiographic outcome of the combination of DFDBA + PRP in treatment of infrabony defects, and the majority of these reports proved a positive outcome (18, 19) , some others failed to prove that PRP + DFDBA is better than DFDBA alone in treatment of infrabony defects(20). Hyaluronic acid has been proven to be effective in treatment of gingivitis (12), as an adjunct to scaling and root planning (13) and as an adjunct to open flap CLINICAL AND RADIOGRAPHIC EVALUATION OF DEMINERALIZED FREEZE-DRIED (1469) debridement( 14). To the best of my knowledge, no data is available on the use of HA plus DFDBA in the treatment of periodontal infrabony defects in humans. Therefore, the present randomized blind study aimed to clinically and radiographially; 1) Evaluate the use of HA plus DFDBA in treatment of periodontal infrabony defects as compared to DFDBA alone. 2) Compare between the use of HA plus DFDBA versus PRP plus DFDBA in treatment of infrabony periodontal defects 12 months after flap surgery. MATERIALS AND METHODS

egyptian dental journal /egyptian dental journal

CLINICAL AND RADIOGRAPHIC EVALUATION OF DEMINERALIZED FREEZE-DRIED BONE ALLOGRAFT PLUS HYALOURONIC ACID VERSUS DEMINERALIZED FREEZE-DRIED BONE ALLOGRAFT PLUS PLATELET-RICH PLASMA FOR THE TREATMENT OF PERIODONTAL INTRABONY DEFECTS – A RANDOMIZED BLIND STUDY