الفهرس 
AbstractOnly 14 pages are availabe for public view
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Abstract
Periodontitis is an inflammatory disease that is caused by an infection in the tissues that support teeth (i.e., the periodontium).Furthermore, the development of the disease, the exposure of vulnerable individuals to its onset, and the rate of advancement are all influenced by genetics, environmental factors, and behavioral variables.The most distinctive aspect of periodontitis is the irreversible loss of alveolar bone that results from the activation of osteoclastogenesis, which also causes a loss of tooth support.An abundance of proteolytic and frequently obligately anaerobic species, as well as inflammation, are caused by excessive dental plaque deposition along the gingival margin (17). An inflammatory reaction in the gingival tissue is triggered by the existence of pathogenic-potential periodontal bacteria in the gingival sulcus. In those who are vulnerable, this can have severe effects on the periodontium if it is allowed to become chronic. The oral microbiota’s metabolic processes and component interactions with the host may maintain the microbiota’s homeostasis or cause disruptions (dysbiosis) (17). Commensals linked to periodontal health are crucial for maintaining equilibrium because they inhibit the growth of bacteria linked to periodontitis, for instance. Subgingival biofilms, however, can undergo qualitative and quantitative changes that lead to disturbed homeostasis. This can cause disease to develop with varying degrees of periodontal tissue loss.Initial or basic periodontal therapy, such as subgingival debridement, has shown to have a significant positive clinical benefit (140), SRP has drawbacks, too, and in certain individuals (grade C periodontitis) its influence could not be sufficient to produce the required outcomes at certain locations. Therefore, other treatment modalities have been developed and evaluated, such as various debridement techniques or adjuvant therapy (antimicrobials, probiotics, anti-inflammatory medications, and antioxidant micronutrients) (142). Antimicrobial therapy for periodontitis can be administered locally or systemically. When compared to drugs used systemically, the primary benefits of local treatment include lower side effects, better compliance, and a lower risk of bacterial resistance to medication(143). The effects of local antimicrobials given in fibers, gels, chips, or microspheres have been evaluated in a variety of studies and systematic reviews, primarily in untreated patients but also in treated locations, with poor response or with recurring disease (144, 145).Locally administered antimicrobials can be found as gels, fibers, chips, polymers, ointments, or other forms containing the relevant medications impregnated in a vehicle. In order to be therapeutically effective, they need to meet certain requirements: The medication must reach its intended site of action, maintain an effective concentration, and endure for a sufficient amount of time (146).Salvadora Persica, a plant that is commonly used to treat a variety of diseases and conditions in traditional medicine in Asia, the Middle East, and Africa due to its anti-oxidant, anti-inflammatory, and anti-bacterial effects, is one of the herbal remedies that show the greatest promise for treating periodontal disease and providing noticeable potential profits. A more recent addition to the local chemotherapeutic drugs is hyaluronic acid (HA). Widely distributed throughout the extracellular matrix, HA actively controls a variety of cell behaviors, such as invasion, chemotaxis, random motility, proliferation, and metabolic processes. Numerous cells, including fibroblasts, produce HA.HA is applied topically as an anti-inflammatory and anti-oedematous agent, and it has a role in tissue repair and wound healing (170) Exogenous hyaluronon may serve as a scavenger by removing prostaglandins, metalloproteinases, and other bioactive compounds, which could explain its anti-inflammatory properties.Objective the aim of this study is to evaluate the efficacy of standardized methanolic extract of salvadora persica (sME-SP) versus hyaluronic acid (HA) as adjunct therapy in treatment of stage I and stage II periodontitis as a split mouth design.MethodA total number of twenty patients were diagnosed with stage I and stage II periodontitis according to the Classification of Periodontal and Peri-Implant Diseases and Conditions 2017. They were selected from the department of Oral Medicine and Periodontology clinic, Faculty of Dentistry, Mansoura University. Complete medical and dental histories were taken from all participants. They also clearly understood the purpose, steps, benefits, and hazards of the study, and signed an informed consent.Patients were subjected to meticulous full mouth debridement using ultrasonic scalers and manual specific Gracey curettes. This step was repeated weekly if indicated. Patients were instructed to maintain good oral hygiene measures throughout the whole treatment period. After 1 week of scaling and root planning baseline recording of Clinical periodontal parameters [ Plaque index (PI), bleeding on probing (BOP), Pocket probing depth (PPD), and Clinical attachment loss (CAL)] were recorded for patients at baseline and 6 weeks after treatment. standardized gel of salvadora persica extract containing 0.8% benzyl isothiocyanate was applied in periodontal pocket of the affected tooth and 0.8% hyaluronic acid gel was injected in the contralateral side (split mouth design). The procedure was repeated after one week. Samples of GCF were collected at baseline and after 6 weeks of treatment.GCF samples were evaluated for IL-6 and TNF-alpha using Human ELISA kit.ResultRegarding inter-group comparison of baseline mean values of the clinical parameters, no statistically significant difference was observed betweenthetwogroups.Considering post treatment mean values of the clinical parameter, there was no obvious statistically significant difference between the two groups with regard to PI, BOP, CAL and PPD.Regarding intra group comparison all clinical parameter revealed a statistically significant difference after 6 weeks of treatment among each group compared to baseline.Regarding TNF-alpha in GCF samples a statistically significant decline was observed in both groups after treatment by both drugs and the Percent of change in TNF Alpha was higher among hyaluronic acid group without statistically significant difference from salvadora persica group. Regarding IL-6 in GCF samples a statistically significant decline was observed in both groups after treatment by both drugs and the percentage of change in IL-6 was higher among hyaluronic acid group without statistically significant difference from salvadora persica group.