الفهرس 
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Abstract
Abstract : Objective : The aim of the present study is to assess the clinical and radiographic effects of strontium ranelate and metal substituted hydroxyapatite in treatment of chronic periodontitis among diabetic patients (clinical study). Also, we evaluated the radiographic and immunehistochemical effects of these drugs in alveolar bone regeneration in diabetic rats (experimental part). Subjects and Methods : 1- Clinical Study :- A randomized split-mouth study was used in 10 controlled type II diabetic patients suffering from periodontal disease with alveolar bone loss. After phase I therapy, they randomly received one of the two proposed treatments in one side and the other treatment in the opposite side according to computer generated table. First Proposed Treatment (group I) : was applied in 10 randomized sides and included a surgical flap with a mix of strontium ranelate 1gm with gengigel. Second Proposed Treatment (group II):- was applied in the 10 opposite sides and included a surgical flap with a mix of metal substituted hydroxyapatite bone graft materials 1gm with gengigel. At first, clinical periodontal health status will be assessed by measuring: Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD), clinical attachment level (CAL) and cone beam computed tomography (CBCT) was taken at baseline. Patients were recalled for follow up and rescoring of all indices after 1, 3, 6 months (CAL and PPD after 3, 6 months) and a CBCT was taken again after 6 months for radiographic assessment. 2-Experimental StudyAnimal selection:-Ten adults male and female rice rats (1month -old) weighting (250- 300g) were used throughout the experiment from the laboratory. After a 24-hour fasting, the rats were injected with a single intraperitoneal dose of freshly prepared alloxan [alloxan monohydrate (1H, 3H) Pirimidintotrone, 150 mg/kg body weight, i.p.] diluted at 0.2% in a 0.05 M citrate buffer, to induce diabetes. Surgical Procedure Experimental Groups :- A month after the injection of alloxan, a randomized split-mouth study was used in the selected diabetic rats to receive one of the two proposed treatments in one side and the other treatment in the opposite sides. This randomization was achieved by computer generated table. First Proposed Treatment (group I) : was applied in 10 randomized sides and included a surgical flap with a mix of strontium ranelate 0.5gm with gengigel. Second Proposed Treatment (group II) :- was applied in the 10 opposite sides and included a surgical flap with a mix of metal substituted hydroxyapatite bone graft materials 0.5gm with gengigel. At baseline, digital periapical radiography was taken a month after the injection of alloxan to see resorbed alveolar bone and was taken again after 3months post-operative surgery for radiographic assessment. Immunohistochemical Examinations Gingival tissue samples were collected from diabetic rats. The specimens were taken by surgical incision longitudinally aimed at sulcular epithelium tissues. 10 gingival specimens, 3x3 mm in dimension were obtained from group I (the buccal sites of mandibular molar area site of strontium ranelate in alveolar bone graft). 10 gingival specimens, 3x3 mm in dimension were obtained from group II (the buccal sites of mandibular molar area, contralateral site of metal substituted hydroxyapatite in alveolar bone graft). After treatment, gingival biopsies of the two groups were immediately kept in 10% formalin in order to be sent to the pathology laboratory and were processed for H&E stain and immune stain for matrix metalloproteinases 2 Patients’ Results : The two treatment modalities showed a statistically significant reduction in PPD and CAL at 3 and 6 months as compared to the mean baseline value. Intergroup comparison showed that group I had significantly less PPD and CAL as compared to group II. Comparing the two sides by CBCT showed increase nearly about 3.4 mm in the height of the alveolar bone in the side of group I (Strontium Ranelate ) while the opposite side in group II (Metal Substituted Hydreoxy Apatite) increase nearly about 1.4 mm in the height of the alveolar bone Experimental Results: Comparing the two sides by digital Periapical radiography showed increase nearly about 0.37 mm in the height of the alveolar bone in the side of group I (Strontium Ranelate) while the other side in group II (Metal Substituted Hydreoxy Apatite) increase nearly about 0.12 mm in the height of the alveolar bone.Immunohistochemical Results: There was much high MMP2 expression in the group II than in the group I, (P value <0.05) which was found by comparing the immunohistochemical results, so the difference between 2 groups is considered statistically significant. Conclusion : A clinical and radiographic result obviously showed statistically significant improvement in the two groups and provides evidence that strontium ranelate group is even more promising in treatment of periodontal diseases. Immunohistochemical results revealed anti-inflammatory effect of strontium ranelate on the soft tissue with periodontal diseases. However, this feature is not present in metal substituted hydroxyapatite bone graft material.