الفهرس 
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Abstract
The present study evaluated clinically, radiographically in humans and histologically in Egyptian native breed of dogs, the efficacy of gelatin sponge loaded with beta-tricalcium phosphate with or without regenerating agent (RGTA), in the treatment of mandibular class II furcation defects in moderate to advanced periodontitis. Twenty mandibular grade II furcation defects in 8 patients, (1male and 7 females) with mandibular grade II furcation involvement were selected. Inclusion criteria comprised class II furcation defects with ≥3 mm horizontal probing depth according to Hamp et al., (18), clinical attachment level (CAL) ≥ 3 mm and absence of relevant medical conditions that contraindicate periodontal surgery. Their ages ranged between 40 to 60 years old. All subjects received initial therapy including scaling & root planing as well as comprehensive oral hygiene instructions. Re-evaluation was conducted after one month to evaluate tissue response and compliance to plaque control measures for their inclusion in the study. The defects were randomly allocated into two groups group I and group II in which the treatment modalities were blinded (10 in each) as they were either RGTA® loaded on gelatin /β tri-calcium phosphate sponge or placebo loaded on gelatin / β tri-calcium phosphate sponge. Comparison between the groups was assessed by the following parameters: 1- Clinical parameters: This included plaque index (PI), probing pocket depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) at baseline, 6 & 12 months post therapy and furcation assessment with graduated Naber’s probe (F) at baseline & 12 months post therapy. During the surgical procedure, the furcation depth (D), height (H) and width (W) were assessed. when comparing between the intrasurgical measurements and CBCT measurements, there was no significant difference between both measurements. 2- Radiographical assessment: CBCT was taken at baseline & 12 months post-surgery. Bone level of the furcation depth (D), height (H) and width (W) from Sagittal, coronal and axial views of CBCT and bone density were assessed. The collected data was statistically analyzed at the different follow up periods. The statistician was blinded of the treatment allocated to any of the groups to prevent bias. 3- Histological assessment: Nine defects in 3 Egyptian native breed of dogs in 3 quadrants (9–10 kg) with a total 18 sites were selected for this study, and class II mandibular buccal furcation defect were induced at each animal. All experimental sites were surgically created (5 mm in height, 3 mm in width) and checked by the periodontal probe to establish the ideal standardized critical sizes experimental defect at the mandibular quadrants then the two treatment modalities were represented in each quadrant separately, with a total of eighteen sites. The animals were euthanized at 12 weeks postoperatively and tissue specimens which consisted of bone segments of the mandible were decalcified in 10 % ethylene-diamine tetraacetic acid (EDTA) solution and were stained with Hematoxylin & Eosin stain following the routine technique. Histomorphometric analysis was carried out using free software image procedure to evaluate histopathological results. The collected data was statistically analyzed at the different follow up periods. The statistician was also blinded of the treatment allocated to any of the clinical and experimental groups to prevent bias. Clinical results: At baseline, statistical analysis of data revealed no significant differences between the measured clinical parameters. The results of the present study showed significant reduction of PD, PI, CAL, BOP and F in the two study groups along different study periods with no significant difference between both groups as revealed by intergroup comparison. Radiographic results: At baseline, statistical analysis of data revealed no significant differences between the measured radiographic parameters. In both groups, the results of bone level gain in height, width and depth of furcation defect showed statistically significant improvement throughout the study period from the baseline till 12months.This improvement was statistically non-significant when comparing between the two study groups. However, the improvement was in favor of group I. The results of bone density revealed a statistically significant improvement in the bone density of the defect from baseline to 12 months in both groups. The improvement in bone density was statistically nonsignificant when comparing between the two study groups, however this improvement was in favor of group I. There was no significant difference between the intrasurgical measurements and CBCT measurements at baseline in both groups Histological results: Experimental defects of all groups showed different types of new attachment with variable degree of regeneration and repair of new cementum, bone, and periodontal fibers. In group I, nine defects showed new bone formation with organized periodontal ligament (PDL)- like tissue and new cellular cementum. Nine defects in group II displayed scattered bone formation with disorganized PDL- like tissue and inflammatory cell infiltrate.