Clinical and biochemical evaluation of the use of locally delivered hyaluronic acid versus injectable PRF (I-PRF) as an adjunctive therapy to non surgical periodontal treatment of severe chronic periodontitis. (Randomized Controlled Study)

Abstract

Periodontitis is chronic inflammatory response to the oral biofilm. The disease is clinically diagnosed by loss of connective tissue attachment and bone around the teeth in conjunction with the formation of periodontal pockets due to the apical migration of the junctional epithelium. Inflammatory mediators are produced as a part of the host response that contributes to tissue destruction, they are such as: MMP and cytokines. The cytokine network which mediates the immune response includes pro-inflammatory cytokines and anti-inflammatory cytokines. During the initiation of an inflammatory response in the periodontal connective tissue, numerous pro- inflammatory cytokines, such as IL-1β, IL-6 and TNF-α, are released from cells of the junctional epithelia, connective tissue fibroblasts and macrophages. Additionally, enzymes such as MMP-8 and -9 are produced by PMNs and osteoclasts, leading to the degradation of connective tissue collagen and alveolar bone. Interleukin 10 (IL-10) is an anti-inflammatory cytokine. It is widely expressed in periodontal tissues during healing process. IL-10 affects a diverse range of cell types which