Effectiveness of nano hydroxyapatite graft with or without platelet rich fibrin membrane in the treatment of periodontal intrabony defects.

Periodontitis is a progressive inflammatory disease which causes destruction of the periodontal ligament and alveolar bone with pocket formation. The ultimate goal of periodontal therapy is the regeneration of periodontal tissues that have been destroyed due to periodontal disease. Periodontal regeneration is the reconstruction of the lost tissues as evidenced histologically in the formation of new cementum, new alveolar bone, and functionally oriented periodontal ligament.2Loss of alveolar bone support is one of the characteristic signs of destructive periodontal disease and is generally considered to represent the anatomical sequelae to the apical spread of periodontitis. The intrabony defects are associated with the loss of tooth support, relates to the site specificity of the periodontal destruction and to the possibility that ecological niches may represent site specific risk factors or indicators for disease progression. Treatment of bony defects is intended to meet two objectives. Elimination of microbial plaque from exposed surfaces of the root and establishing the anatomy of effected surfaces that facilitates proper self-performed plaque control.Different types of bone grafts are used to fill the periodontal defects and restore the lost periodontal attachment apparatus such as autografts, allografts and alloplastic materials.Alloplasts are synthetic, inorganic, biocompatible and non-antigenic graft substitutes. Eggshell derived hydroxyapatite is hydrophilic in nature, absorbed by body fluids and blood, so that handling becomes easy for placing it in the surgical site. Lack of disease transfer risks, biocompatibility, and ease of use makes it a viable choice as regenerative material. Hydroxyapatite is a naturally occurring mineral component of bone and is osteoconductive in nature. PRF membrane is a second-generation autologous platelet concentrate and is a fibrin mesh consisting of leukocytes and cytokines. It activates the vascular system and angiogenesis and releases growth factors like PDGF, insulin like growth factor, vascular endothelial growth factor, and TGF, which are involved in soft and hard tissue healing. PRF has been utilized for a variety of clinical procedures acting as an autologous barrier membrane for the treatment of intrabony periodontal defects.  PRF has a proliferative effect on different types of cells such as osteoblasts, gingival fibroblasts, and PDL cells. Thus, this homogenous fibrin network is considered as healing biomaterial and is used to enhance bone regeneration. Two dimensional radiographic methods such as IOPA, bitewing radiographs, periapical radiographs and OPG are severely limited by the inherent overlay of anatomic structures and the difficulty to reproduce angles over time. Cone beam computed tomography (CBCT) enables cross-sectional and 3D analysis without distortion and evaluating osseous defects with high resolution. To evaluate the effectiveness of nano hydroxyapatite graft which may help in achieving favorable bone regeneration by promoting healing and platelet rich fibrin membrane when used in combination provides graft stabilization and improves clinical parameters in the intra bony defects.