الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
The of the extraction socket causes atrophy of the alveolar ridge, reducing the width of the alveolar ridge by 50%. which leads to aesthetic problem, soft tissue recession, or hinder dental implant placement dictating guided bone regeneration
Alveolar ridge preservation is an effective procedure for minimizing ridge resorption after tooth extraction regarding the original dimension. ARP techniques based on non-traumatic extraction and flapless approach, bone substate materials, socket seal concept using barrier membrane gingival graft.
Materials used for socket sealing includes epithelial graft, CM, collagen membrane, ADM, and PTFEm. Socket grafts filling materials includes bone allografts, xenografts, and allogeneic implants.
Bone graft materials should be osteogenic, osteoinductive and osteoconductive. biocompatible, mechanical stability inside defects. Xenografts are bone grafts that are transplanted from one species to another, such as bovine, and used as a calcified matrix. Main problem with xenografts is antigenicity due to protein content. Deproteinization solve the problem however it damages collagen fibres contents that serve as a starting point for bone calcification and cell adhesion and proliferation. Xenografts lack organic cellular components and thus have no bone formation potential. To address this issue, xenografts must be placed in a bone formation environment or combined with an autologous bone matrix to encourage natural bone formation.
Growth factors were used in regenerative therapy to accelerate new bone formation during ridge preservation and act as signalling molecules that modulate cell growth and development. Injectable PRF (I-PRF) PRF contains various growth factors such as TGF-β1, PDGF, VEGF, BMP2 and anti-inflammatory cytokines such as IL4, IL10 and IL6. IL-4. Previous content contributes to cell proliferation, migration, and angiogenesis required for tissue regeneration.
Hyaluronic acid is natural scaffold material, which is beneficial for bone regeneration by chemotaxis, enhancing osteoblastic differentiation, bone induction by substances as bone morphogenetic protein-2 (BMP-2) and osteopontin, inhibition of BMP antagonists, anti-inflammatory, anti-oedematous and anti-bacterial effects.
Both Hyaluronic acid and Injectable PRF can enhance the bone forming ability when mixed with to enhance bone xenograft formation the present study aims to evaluate the use of I-PRF versus Hyaluronic Acid mixed with xenograft in alveolar socket augmentation covered by free gingival graft Clinically and radiographically, and Histologically.
The study included twenty-four patients divided in three groups each consists of eight patients for socket augmentation procedure. group Ⅰ, ARA was performed using I-PRF and mixed with particulate xenograft. group Ⅱ, socket augmentation was performed using hyaluronic acid mixed with xenograft. group Ⅲ, socket augmentation was performed using xenograft alone as positive controlled group. All extraction sockets sealed with free gingival graft. All the patients received implant after 4 months in the socket augmentation site.
Before extraction data for each patient was recorded as following Pre-baseline (CBCT), Clinical Preoperative records of: Horizontal bone width, Width of keratinized gingiva and phenotype.
Atraumatic extraction was done, group 1: socket augmentation was performed using I-PRF and mixed with particulate xenograft sealed with free gingival graft. group 2: socket augmentation was performed using hyaluronic acid mixed with xenograft sealed with free gingival graft. group 3: socket augmentation was performed using xenograft sealed with free gingival graft.
After 4 months from the grafting surgery same data of preoperative was recorded again as following: CBCT, Clinical Preoperative records of: Horizontal bone width, Width of keratinized gingiva and phenotype, then re-entry procedure was performed to take bone core biopsy for histological analysis, and to place implants.
Clinical records pre and post operative was compared, CBCT (base line and after 4 months) was compared using fusion technique, histological data of newly formed bone and residual graft was recorded.
Regarding clinical soft tissue thickness there was no statistically significant difference between the three groups at the base line data or after 4 months, however I-PRF group showed increase of soft tissue thickness 0.25±0.12A, on the counter of hyaluronic acid group which showed loss of soft tissue thickness-0.12±0.08C, control group showed no change at soft tissue thickness.
Regarding keratinized tissue thickness there was no statistically significant difference between the three groups at the base line data or after 4 months. Mean value of keratinized gingiva intragroup showed slight decrease at tissue width for I-PRF group and HA group (-0.25), meanwhile control group showed the highest decrease (-0.50)
Regarding clinical bone width Decrease was recorded for the three groups after 4 months. The highest decrease of mean values was found in in I-PRF group (-0.88±0.58), followed by HA group (-0.50±0.46), while the lowest decrease was found in the control group (-0.44±1.35).
Regarding Radiographic bone width Decrease was recorded in all groups. The highest decrease of was found in control group followed by HA group, the lowest decrease was found in the I-PRF group.
Crestal bone height change clinically had similar results The highest decrease was found in the control group (3.45±2.13), followed by I-PRF group (-2.65±0.45), while the lowest value was found in HA group (-4.18±1.73) yet the difference between different groups was not statistically significant.
Regarding area fraction of new bone There was a significant difference between different groups. The highest value was found in HA group (56.66±7.35), followed by I-PRF group (28.74±5.15), while the lowest value was found in the control group (24.05±3.64). Regarding area fraction of residual graft, The highest value was found in I-PRF group (6.76±2.59), followed by the control group (2.71±1.24), while the lowest value was found in HA group (2.63±1.27).
It was concluded that both HA and I-PRF added beneficial effect to xenograft regarding alveolar ridge augmentation.