الفهرس 
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Abstract
Periodontitis is an infection-driven inflammatory disease in which the composition of biofilms plays a significant role. Dental plaque accumulation at the gingival margin initiates an inflammatory response that, in turn, causes microbial alterations and may lead to drastic consequences in the periodontium of susceptible individuals.(1) The prevention of bone loss associated with periodontitis through host-response modulation may be an effective adjuvant treatment associated with SRP. Thus, the use of anti-resorptive drugs may provide an effective alternative adjuvant therapy for periodontitis.(2) Hence, pharmacological agents, like bisphosphonates, which modulate host responses are being tested as treatment modalities for periodontal lesions.(3) Alendronate (ALN), an aminobisphosphonate is a potent inhibitor of osteoclast-mediated bone resorption with no adverse effect on the mineralization of bone. (4) Bisphosphonates play an important role in accelerating bone formation as it stimulates osteogenesis in conjunction with regenerative materials around osseous defects.(5) A variety of grafting materialshave been used in bone grafting for the treatment of periodontal defects to obtain periodontal tissue regeneration.(6) Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects, which has resulted in clinically acceptable responses.(7) It has been shown that HA bone grafts have excellent bone-conductive properties which permit outgrowth of osteogenic cells from existing bone surfaces into adjacent bone graft material.(8) Due to the effectiveness of ALN in reducing alveolar bone resorption and due to the advantages of hydroxyapatite (HA) bone grafting material in guided tissue regeneration (GTR), it was worth using both materials in order to obtain better results in treatment of periodontal defects . Objective : To evaluate the Effect of Alendronate gel (1%) in combination with Hydroxyapatite (HA) in the regeneration of periodontal defects in periodontitis patients (Clinically and Radiographically). Methods : Fourty, otherwise systemically healthy, periodontitis patients (28 males and 12 females, aged between 40 and 55 years) were included in the study. They were classified into four group, 1st group composed of ten patients treated with Alendronate gel (1%) in combination with Hydroxyapatite (HA) and periodontal flap surgery. 2nd group composed of ten patients treated with Alendronate gel(1%) and periodontal flap surgery. 3rd group composed of ten patients treated with Hydroxyapatite (HA) and periodontal flap surgery. 4th group composed of ten patients treated with periodontal flap surgery alone. Clinical parameters (Plaque Index (PI), , Gingival Index (GI),Periodontal probing depth (PPD), Clinical attachment level (CAL) and Radiographic parameters were assessed at baseline and 6 months after treatment by Periapical Radiograph using parallel technique. The anatomical landmarks of cemento-enamel junction (CEJ) and base of defect (BD) were marked by periapical radiograph using parallel technique. Radiographic changes from cemento – enamel junction (CEJ) to base of defect (BD) were assessed from baseline and 6 months after treatment. Bone gain was measured from baseline and 6 months after treatment. Results : In group I (ALN 1% gel + HA ) the mean value of plaque index (PI) at the baseline before surgery was 2.6±0.5, while after 6 months it was 0.6±0.5. The mean value of gingival index (GI) at the baseline before surgery was 2.7±0.7 , while after 6 months it was 0.8±0.6. The mean value of clinical probing depth (PD) at the baseline was 7.4±1.1, while after 6 months it was 5.2±1.2. The mean value of clinical attachment level (CAL) at the baseline before surgery was 7.5±1.2, while after 6 months it was 5.3±1.3. The mean value of the amount of bone gain in group (1) was 2.2±0.6mm. In group II (ALN 1% gel) the mean value of plaque index (PI) at the baseline before surgery was 2.5±0.5,while after 6 months it was 0.9±0.6. The mean value of gingival index (GI) at the baseline before surgery was 2.7±0.5 ,while after 6 months it was 0.9±0.7. The mean value of clinical probing depth (PD) at the baseline was 7.3±0.9,while after 6 months it was 5.3±1. The mean value of clinical attachment level (CAL) at the baseline before surgery was 7.4±0.9 , while after 6 months it was 5.5±0.8. The mean value of the amount of bone gain in group (2) was 1.7±0.4 mm. In group III (HA) the mean value of plaque index (PI) at the baseline before surgery was 2.6±0.5, while after 6 months it was 1.0±0.7. The mean value of gingival index (GI) at the baseline before surgery was 2.6±0.5, while after 6 months it was 0.8±0.6. The mean value of clinical probing depth (PD) at the baseline was 7.9±0.9, while after 6 months it was 6 ±0.8. The mean value of clinical attachment level (CAL) at the baseline before surgery was 8.1±0.8, while after 6 months it was 6.2±0.9. The mean value of the amount of bone gain in group (3) was 1.9±0.7 mm. In group IV (Minimally invasive surgical technique) the mean value of plaque index (PI) at the baseline before surgery was 2.7±0.5, while after 6 months it was 0.8±0.7. The mean value of gingival index (GI) at the baseline before surgery was 2.7±0.5, while after 6 months it was 0.8±0.8. The mean value of clinical probing depth (PD) at the baseline was 7.5±1.1, while after 6 months it was 7±1.1. The mean value of clinical attachment level (CAL) at the baseline before surgery was 7.5±0.9,while after 6 months it was 6.9±1.1. The mean value of the amount of bone gain in group(4) was 0.7±0.6 mm. Conclusions : Combination of Alendronate gel( 1%) and (HA) gave good results in the treatment outcomes as regard bone level and periodontal clinical parameters. Alendronate gel (1%) in combination with (HA) showed a synergistic effect on regeneration of vertical bony defects. The application of Alendronate gel 1% gel alone as a regenerative material in vertical bony defect gave a promising predictable outcome regarding bone level gain and periodontal clinical parameters improvements. Although (HA) showed good results as regard improving bone level and periodontal clinical parameters, but it was not as effective as when it was combined with Alendronate gel 1%.