الفهرس 
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Abstract
SUMMARY
P
eriodontitis is an infectious disease of the periodontal tissue that can lead to tooth loss in adults. The lost periodontium, including both hard (alveolar bone and cementum) and soft (periodontal ligament) tissues, needs to be restored to its original architecture. The complex microenvironment of the periodontal wound creates many challenges associated with the regeneration of multiple tissue types within periodontal lesions.
Guided tissue regeneration (GTR) with barrier membranes has been established to be effective in periodontal regeneration. GTR has several important fuctions including; blood clot stabilization, ability to attain primary intention wound healing, keep the defect isolated from the gingival fibroblasts and their extracellular matrix (ECM), and space maintenance. During a GTR procedure, the membrane excludes any contribution of mesenchymal stem cells and osteoblasts from the periosteum and gingival tissue. The human gingival tissue contains numerous types of cells, like gingival fibroblasts and gingival mesenchymal cells.
Fibroblasts are abundant mesenchymal cells that play important roles in development and tissue repair. Recent studies have reported that direct conversion of fibroblast into another differentiated lineage can be accomplished.
GMSCs are a population of MSCs derived from human gingiva that are also capable of self-renewal, multipotent differentiation, and immunomodulation. Gingival sample can be easily obtained in the clinic, and the isolation of GMSCs is simple, making GMSCs good candidates for tissue regeneration and cell-based therapy.
Furthermore, extracellular matrix components (ECM) is regulating cell to cell talking and gene expression. So that, the gingival fibroblasts (GF) extraction from gingival ECM would break all connection with surrounding environment. This isolated healthy GF can be differentiated into osteoblast. So that, gingival fibroblast (GF) can share in regeneration of the periodontium when isolated from their ECM and translocate in another place with different ECM.
The present study aimed to evaluate the regenerative potentials of cultured gingival fibroblasts and its associated GMSCs carried by beta tri calcium phosphate into intrabony periodontal defects in human.
Twenty posterior teeth with angular defects were involved in our study. Phase I periodontal therapy was done, after that the oral hygiene measures were instructed to all patients. Ten sites treated by (β TCP) bone graft alone which act as control group (group I), while (group II) treated by GF and GMSCs seeded in (β TCP) scaffold and covered by resorbable collagen membrane. According to our knowledge, this study is the first report of the use of a GF and GMSCs in intrabony periodontal defects to enhance the periodontal regeneration.
Moreover, clinical assessments including vertical pocket depth VPD, clinical attachment level (CAL), plaque and gingival bleeding indices were assessed at baseline and after 6 months. CBCT scan was performed to evaluate the bone fill after 6 months. Also, the biochemical analysis of PDGF-BB and BMP2 in GCF was done in days 1, 3, 7, 14 postsurgical.
The results of the present study revealed that there was statistically significant decrease in VPD and gain in CAL in both groups. The greater VPD reduction and CAL gain were recorded in group II .There was a highly statistically significant differences between group II and I regarding VPD and CAL between both groups postoperatively.
Regarding the radiographic fusion, there was very highly statistically significant difference between group II and I groups. Also, the results of biochemical analysis reported significant increase in PDGF-BB in group II than group I.
According to our result, the use of GF/GMSCs mixtures carried on a vehicle of β TCP and covered by collagen membrane give better result than β TCP alone in clinical outcome of periodontal intrabony defect treatment. The extraction of cells from a small piece of tissue is more or less easily procedure to give better results in periodontal regeneration (The new era of periodontal defect treatment