الفهرس 
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Abstract
The Present Study evaluated clinically and radiographically by cone beam computed tomography the effectiveness of different treatment modalities in the management of mandibular grade III furcation defects using autogenous bone graft (group I), biphasic calcium phosphate (group II), biphasic calcium phosphate plus hyaluronic acid (group III). The experimental part of the study evaluated the probable osseous regenerative potential of the above-mentioned materials in experimentally created bony defects in rabbit’s femur both histologically and histomorphometrically. A total of 21 mandibular grade III furcation defects in 21 patients suffering from chronic periodontitis were selected in this study. selected defects were divided into three groups of seven defects each to receive the tested treatment modalities as mentioned above. The human study design The defects were randomly allocated into 3 groups 7 defects each − group I (control group): 7 grade III furcation defects received autogenous bone graft and serve as control group. − group II: 7 grade III furcation defects received biphasic calcium phosphate bone graft (easy-graft CRYSTAL) − group III: 7 grade III furcation defects received Easy-graft CRYSTAL bone graft and Hyaluronic acid gel (hyaDENT BG) Clinical assessment Clinical assessment for all cases was performed at baseline, at 6 and 9 months post-surgery. Clinical assessment includes the following parameters; plaque index, papillary bleeding index, probing pocket depth, vertical clinical attachment level and horizontal clinical attachment level. Cone Beam computed tomography assessment Cone beam computed tomography was performed to compare before treatment and 9 months after treatment. The obtained cone beam images from group I (control group), group II and group III were analyzed using the Simplant 17.01 pro software. The mean difference of tissue gain and the mean percentage of furcation closure were calculated. The experimental study design Three white New Zealand rabbits were included in this study. Three identical bony defects were created in each femur. The defects were filled with one of the materials used in this study: − Site 1: Autogenous bone graft. − Site 2: Biphasic calcium phosphate phosphate (easy-graft CRYSTAL) − Site 3: Easy-graft CRYSTAL and Hyaluronic acid gel (Hyadent BG). Rabbits were sacrificed after 6 weeks. Samples were collected from the surgical defects for histologic and histomorphometric examinations. Statistical analysis Clinical data was collected at baseline; six and nine months postoperatively, tabulated and statistically analyzed using SPSS software for windows version 25. The histologist and statistician were not aware of the treatment allocated to any of the groups to prevent bias. Clinical results A high statistically significant difference in the clinical parameters was found in all study groups at 9 months post-surgery. Intergroup comparison showed a statistically significant difference in plaque index at 6 months follow up period and a statistically significant difference in vertical clinical attachment level at 9 months follow up period. However, no statistically significant difference was found between the three studied groups in the remaining clinical parameters throughout the study period. Radiographic results The mean difference of tissue gain was 189.17 ± 24.36, 232.94 ± 121.84 and 355.84 ± 152.05 and the mean percentage of furcation closure was 78.34 ± 2.53, 83.21 ± 9.64 and 85.35 ± 8.19 for group I, II and III respectively. group III showed the highest mean difference of tissue gain and the highest mean percentage of furcation closure. However, a statistically significant difference was only observed between group I, II and III regarding the mean difference of tissue gain (p ≤ 0.05). No statistically significant difference was found between the studied groups regarding the mean percentage of furcation closure. Histological results No operative or postoperative complications were encountered. All materials used in this study produced favorable response and bone regeneration according to histological examination. Histomorphometric results The mean percentage of new bone formation in group I was 43.09% ± 2.23% and in group II, it was 31.17% ± 7.27% while in group III it was 37.82% ± 8.98 %. Comparing group I, II and III regarding the percentage of new bone formation showed that there was a statistically significant difference between the three groups in favor of group I (p ≤ 0.05). Conclusion: The overall observations of the present study showed encouraging outcome and showed promising results with significant reduction in clinical parameters and bone formation as evidenced by the tissue gain in the furcation area with the use of autogenous graft, biphasic calcium phosphate with or without hyaluronic acid in the treatment of grade III furcation defects as they can promote periodontal regeneration and enhance healing of periodontal wounds as evidenced by clinical, CBCT results, histological and histomorphometric results. Bone formation and periodontal regeneration can be enhanced by the addition of hyaluronic acid to the bone substitute materials.