Socket Augmentation Using Atorvastatin With Or Without PRGF Derived Fibrin Scaffold (Clinical and Histomorphometric Study)
Phase: PHASE4
Conditions: Socket Preservation
Sponsor: Ain Shams University

 
0 
Socket Augmentation Using Atorvastatin With 
Or Without PRGF Derived Fibrin Scaffold  
(Clinical and Histomorphometric study) 
 
Proposal submitted in partial fulfillment of the requirements of master degree in  
Oral Medicine, Periodontology and Oral Diagnosis 
 
 
BY 
Noha Nasr El-Zalabany 
B.D.S (Ain Shams University, 2006) 
 
SUPERVISORS 
PROF. DR. KHALED ABD EL-GHAFFAR 
PROFESSOR OF ORAL MEDICINE, PERIODONTOLOGY, AND ORAL DIAGNOSIS & THE 
DEAN OF FACULTY OF DENTISTRY, AIN SHAMS UNIVERSITY 
 
PROF. DR. EHAB SAEED ABD El HAMID 
PROFESSOR OF ORAL PATHOLOGY AND VICE DEAN OF POSTGRADUATE AFFAIRS 
FACULTY OF DENTISTRY, AIN SHAMS UNIVERSITY 
 
DR. OLA MOHAMMED EZZATT  
LECTURER OF ORAL MEDICINE, PERIODONTOLOGY, AND ORAL DIAGNOSIS 
FACULTY OF DENTISTRY, AIN SHAMS UNIVERSITY 
 
FACULTY OF DENTISTRY 
AIN SHAMS UNIVERSITY 
2015 
 
 

 
1 
Introduction 
 
       Approximately 50% of alveolar ridge reduction in thickness occurs over a 6–12 
months period after tooth extraction (Johnson K. 1969). The severity of bone loss and 
the healing pattern may pose a problem for the clinician in 2 ways: it creates an 
esthetic problem in the fabrication of an implant-supported restoration or a 
conventional prosthesis; and it may make the placement of an implant challenging if 
not unfeasible (Lekovic V, et al. 1998). Furthermore, the placement of an implant 
requires sufficient alveolar bone support because lack of bone volume is correlated 
with poor osseointegration (Iasella JM, et al. 2003). 
        Immediately after tooth extraction a cascade of inflammatory reactions is 
activated, the alveolar socket is filled by blood clot that is replaced by granulation 
tissue within 1 week; the epithelium migrates over the granulation tissue to cover the 
healing socket. Starting from the apical and lateral residual bony walls, the granulation 
tissue is rapidly remodeled to provisional matrix. Mineralizing processes occurs 
leading to the formation of woven bone that eventually is replaced by mature lamellar 
bone (Trombelli L, et al. 2008, Giorgio P, et al 2012) 
         Bone depositions continue for several months but will not reach the coronal bone 
level of the neighboring teeth(Schropp L, et al. 2003). Significant resorption of the 
alveolar ridge occurs after tooth extraction(Araujo MG & Lindhe G, et al. 2005). 
        The degree of residual ridge resorption is closely related to the time since tooth 
extraction in both maxilla and mandible(Ulm C, et al.1992).The reduction in width is 
usually greater than the loss in height,and bone resorption is significantly larger at the 
buccal than at the lingual side (Lekovic V, et al.1997). 
According to the Osteology Consensus Group 2011, ridge preservation is a general 
term for interventions that aim to preserve the ridge volume within the envelope 
existing at the time of extraction(Christoph HF, et al 2011). 

 
2 
           In order to reduce alveolar bone dimensional changes, several techniques 
aiming at enhancing the regeneration process in the extraction socket have been 
adopted, Such as filling the socket with autogenous bone graftsor bone 
substitutes,guided bone regeneration (GBR) with resorbable or non-resorbable 
barriersand the use of various bone promoting molecules such as enamel matrix 
derivativerecombinant growth and differentiation factorsand autologous platelet 
concentrates(Darbyl I, et al. 2009,  Horowitz R, et al. 2012). 
          Statins (hydroxymethylglutaryl co-enzyme A reductase inhibitors) are a group 
of lipid-lowering drugs that are widely used to prevent cardiovascular events (Sotiriou 
CG & Cheng JW. 2000), they are used orally to treat hypercholesterolaemia and 
hyperlipidaemia with well documented safety profile (Guthrie RM, 2006). 
          Furthermore, statins have been reported to stimulate the expression of bone 
anabolic factors, such as vascular endothelial growth factor and BMP-2 (Maeda T, et 
al. 2003), and to promote osteoblast differentiation and mineralization. In addition, it 
has been suggested that statins directly affect osteoclasts through mechanisms 
analogous to those of bisphosphonates (Staal A, et al. 2003, Maeda T, et al.2004). 
           Statins can also modify the inflammatory cascades through pleiotropic actions 
at multiple levels, such as changing inflammatory mediators, altering leukocyte–
endothelial cell interaction, and reducing expression of major histocompatibility 
complex- II (Terblanche M, et al. 2007). 
           Among statin drugs; Atrovastatin (ATV) has been demonstrated to exhibit 
favorable effects in the treatment of bone remodeling disorders and bone fractures 
through the promotion of osteogenesis and the reduction of bone resorption (Wang JW, 
et al. 2007).  
           The successful use of ATV to promote bone formation in vivo depends on the 
local concentration and there have been continuous efforts to find an appropriate 

 
3 
delivery system (Kishida Y, et al.1991), which allow localization and retention of the 
molecule and providing a matrix for mesenchymal cell infiltration and a substrate for 
cell growth and differentiation with degradation rate that does not inhibit bone growth 
and prevent fibrous tissue formation or fibrous encapsulation of the carrier (Elavarasu 
S, et al. 2012). 
          However, the most important limitation of local delivery vehicles is that the 
main bulk of the delivery vehicle or its acidic degradation products could interfere 
with regenerating tissues (Marzouk KM, et al. 2007). In addition, tissue-implanted 
materials could be surface friendly to biofilm-forming bacteria (Becker PL, et al. 1994). 
          Plasma rich in growth factors is an autologous technology using calcium ions to 
activate growth factor delivery from the platelets and to develop a fibrin network with 
the aim of promoting tissue regeneration (Anitua E, et al. 2007). This 100% autologous 
preparation not only enhances tissue healing but also improves the clinical outcomes 
of various surgical procedures by minimizing complications like pain, inflammation 
and morbidity (Anitua E, et al. 2013a).However, PRGF act on already differentiated 
cells, such as preosteoblasts and osteoblasts; however, they do not exert any effects on 
the stem cells present in bone tissue, whose differentiation is regulated by bone 
morphogenetic proteins (Anitua E, et al. 2013b). 
          Despite the numerous studies describing the benefits of PRGF (Nazaroglou I, et 
al. 2009, Rivera C, et al. 2013) and Statins separately , (Sato D, et al.2005, Nishimura K 
.2008) there has been a lack of clinical investigation into the simultaneous use of these 
agents in socket augmentation. Therefore the main objective of this study is to 
evaluate socket bone dimensions and quality following the use of PRGF derived fibrin 
scaffold as a carrier for Atorvastatinin socket augmentation clinically and 
histomorphometrically. 
 

 
4 
Aim of the study 
 
 
This study will be performed to: 
 
Compare 8 weeks postextraction augmented sockets using Atorvastatin loaded in 
Plasma rich in growth factors derived fibrin scaffold (PRGF/ATV) versus direct 
application of Atorvastatin (ATV) gel using: 
 
1) Histomorphometric analysis of bone quality. 
2) Clinical measurments of dimensional changes after extraction. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
5 
Subjects and methods 
 
 
Thirty patients will be selected from the outpatient clinic of Oral Medicine, 
Periodontology, and Oral Diagnosis department, Faculty of Dentistry, Ain Shams 
University   
 
Inclusions criteria: 
 
1. Healthy adult patients as evidenced by Burkett’s oral medicine health history 
questionnaire. 
2. Both sexes. 
3. Age from 20 –50 years old. 
4. Having at least one hopeless tooth indicated for extraction. 
5. Patient should agree to sign a written consent after the nature of the study will be 
explained. 
 
Exclusion criteria: 
 
1. Smokers. 
2. Pregnant and breast feeding females. 
3. Prisoners and handicapped patients. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
6 
 
Patients met the eligibility criteria will be randomly allocated using sequentially 
numbered sealed envelopes into 3 treatment modalities groups:- 
 
Group I (PRGF/ATV): Will include 10 patients undergoing single tooth extraction 
followed by socket fill with PRGF loaded with Atorvastatin then suturing the socket. 
 
Group II (ATV):   Will include 10 patients undergoing single tooth extraction 
followed by socket fill with Atrovastatin gel then suturing the socket. 
 
Group IIIEmpty socket( control) : Will include 10 patients undergoing single tooth 
extraction then suturing the socket.  
 
All patients will receive implants after taking the bone biopsy after 8 weeks for 
histomorphometric analysis.  
 
This proposal will be reviewed by the research ethics committee, the procedure will be 
fully explained to the patients and they will sign an informed consent. 
 
 
 
 
 
 
 
 
 
 
 

 
7 
 
Surgical procedure and clinical measurements: 
1- Patients will undergo atraumatic extraction under local anesthesia for the involved 
tooth, to preserve bone and soft tissue followed by socket curettage. 
2- Prior to surgery baseline clinical measurements (bone height measured by 
periodontal probe and bone width by bone caliper) will be taken for the alveolar ridge. 
3- Socket will be filled with one of the assigned augmentation modalities; 
Preparation of PRGF/ATV : 
9ml venous blood will be collected from the same patient from peripheral circulation   
The blood will be deposited in 3.8% w\v sodium citrate 1:9v\v. Platelet-rich in growth 
factors will be separated by centrifugation at 580 g for 8 minutes at room temperature. 
After centrifugation blood will be separated into plasma and cells, fractionation of 
plasma into 3 fractions: 
Platelet very rich in growth factors -  F3                                                                   
Plasma with growth factors -F2 
Plasma poor with growth factors - F1 
To produce the (PRGF)(F3) loaded with Atorvastatin we will obtained by carefully 
pipeting a 1ml fraction of plasma immediately above the red blood then mixed with a 
weighted amount of Atrovastatin powder to produce 1.2% (PRGF /ATV) formulation, 
then 10% calcium chloride (50 µL for each 1 ml plasma) will be added and incubated 
for 20 minutes in 37 c to produce a semi-solid mass (Anitua E, 2001). 
 
 
Preparation of 1.2% (ATV) gel: 
Atrovastatin methylcellulose gel will be prepared, by adding the required amount of 
biocompatible solvent to an accurately weighed amount of methylcellulose heated to 
obtain a clear solution then a weighed amount of ATV will be added to the above 

 
8 
solution and dissolved completely to obtain a homogeneous phase of polymer with a 
concentration 1.2% as described by Pradeep AR, et al. 2013. 
 
4- Socket will be sutured.  
5-Postoperative medications will include (Amoxicillin 500 mg t.d.s, Flagyl 500 mg 
twice/day and antiseptic mouth wash for 1 week). 
6- Post operative instruction will be given to the patient and Suture will be removed 
after 1-2 weeks post operatively  
7- Patient will be instructed to avoid wearing any prosthetic restoration.  
8-After 8 weeks patient will come for postoperative clinical measurements and for 
taking biopsy and implant placement. 
 
Histological Examination :-  
 
Bone Biopsy will be taken by a trephine bur  and  the implant will be inserted in the 
same visit , and correspond to a type 2 delay according to the International Team for 
Implantology classification (Chen ST & Buser D.2008). 
10- All the biopsy specimens will be fixed in 10% buffered formalin and 
demineralized in 10% ethylenediamine tetra acidic acid solution. A 7-μm-thick 
longitudinal section, representing the central part of each core specimen, will be  
stained with hematoxylin and eosin (H&E) for histologic examination. The histologic 
section will be examined using a research light microscope, and photomicrographs 
will be taken with the attached digital camera. 
11- Histomorphometric measurement of the tissue image will be performed using the 
image analysis software. 
• Total area of newly regenerated tissue including the newely formed bone above the 
old basal bone within the obtained core and the adjacent soft tissue . 

 
9 
Statistical analysis: 
 
All the clinical and histomorphometric  data will be collected, tabulated and subjected 
to statistical analysis. 
References 
 
- Anitua E: The use of plasma-rich growth factors (PRGF) in oral surgery. Pract Proced 
Aesthet Dent. 13(6):487-93. 2001. 
 
- Anitua  E, Sanchez M, Orive G, Andia I: The potential impact of the preparation rich in 
growth factors (PRGF) in different medical fields. Biomaterials 28: 4551–4560. 2007. 
 
- Anitua, E., Tejero, R., Alkhraisat, M., Orive, G: Platelet-rich plasma to improve the bio-
functionality of biomaterials. Bio Drugs 27: 97–111. 2013a. 
 
- Anitua E, Tejero R, Zalduendo MM, Orive G: Plasma rich in growth factors promotes 
bone tissue regeneration by stimulating proliferation, migration, and autocrine secretion in 
primary human osteoblasts.J Periodontol. 84(8):1180-90. 2013b. 
 
- Araujo MG, Lindhe J: Dimensional ridge alterations following tooth extraction. An 
experimental study in the dog. J clin periodontal ;32:212-218. 2005. 
 
- Becker PL, Smith RA, Williams RS, Dutkowsky JP: Comparison of antibiotic release from 
polymethylme- thacrylate beads and sponge collagen. J Orthop Res. 12:737-741. 1994. 
 
- Chen ST & Buser D: Implants in post extraction sites: treatment options. Berlin, Germany: 
quintessence pub.co.,Ltd. 9-15. 2008. 
 
- Christoph HF, Hämmerle, Mauricio G. Araújo, Massimo Simion and On Behalf of the 
Osteology Consensus Group 2011: Evidence-based knowledge on the biology and 
treatment of extraction sockets. Clinical oral implant research; 23(S5):80–82. 2011. 
 
- Darbyl I, Chen ST, Buser D: Ridge preservation techniques for implant therapy. Int J Oral 
Maxillofac Implants;24(suppl):260-271. 2009. 
 
- Elavarasu S, Suthanthiran TK, Naveen D: Statins: A new era in local drug delivery. J 
Pharm Bioallied Sci.  4(S2): 48-51. 2012. 
 

 
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- Giorgio P, Gaia P, William V. Giannobile, Giulio R: Postextraction Alveolar Ridge 
Preservation: Biological Basis and Treatments. Int J Dent; 2012: 151030. 2012. 
 
- Guthrie RM: How safe is aggressive statin therapy? Progress in Cardiovascular Nursing. 
21: 140–145. 2006. 
 
- Horowitz R, Holtzclaw D, Rosen PS: A review on alveolar ridge preservation following 
tooth extraction. J Evid Based Dent Pract; 12(3s):149-60. 2012. 
 
- Iasella JM, Greenwell H, Miller RL: Ridge preservation with freeze-dried bone allograft 
and a collagen membrane compared to extraction alone for implant site development: a 
clinical and histologic study in humans. J Periodontol; 74: 990–999. 2003. 
 
- Johnson K: A study of the dimensional changes occurring in the maxilla after tooth 
extraction. Australian Dental Journal; 14: 241–244. 1969. 
 
- Kishida Y, Naito A, Iwado S, Terahara A, Tsujita Y: Research and development of 
pravastatin. Yakugaku Zasshi.111:469-87.1991. 
 
- Lekovic V, Kenney EB, Weinlaender M:  A bone regenerative approach to alveolar ridge 
maintenance following tooth extraction. Report of 10 cases. J Periodontol ;68:563–570. 
1997. 
 
- Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, 
and other. Preservation of alveolar bone in extraction sockets using bioabsorbable 
membranes. J Periodontol; 69(9):1044–1049. 1998. 
 
- Maeda T, Kawane T, Horiuchi N: Statins augment vascular endothelial growth factor 
expression 
in 
osteoblastic 
cells 
via 
inhibition 
of 
protein 
prenylation. 
Endocrinology.144:681-692. 2003. 
 
- Maeda T, Matsunuma A, Kurahashi I, Yanagawa T, Yoshida H, Horiuchi N: Induction of 
osteoblast differentiation indices by statins in MC3T3-E1 cells. J Cell Biochem. 92:458-
471. 2004. 
 
- Marzouk KM, Gamal AY, Al-Awady AA, Sharawy MM: Osteoconductive effects of vinyl 
styrene microbeads in rat calvarial defects: J Oral Maxillofac Surg. 65:1508-1516. 2007. 
 
- Nazaroglou I, Stavrianos C, Kafas P: Radiographic evaluation of bone regeneration after 
the application of plasma rich in growth factors in a lower third molar socket: a case 
report. Cases J; 2: 9134. 2009. 

 
11 
- Nishimura K: Local application of simvastatin to rat incisor sockets augments bone. 
kokubyo Gakkai Zasshi. 75(1): 49-54. 2008. 
 
- Pradeep 
AR, Kumari 
M, Rao 
NS, Martande 
SS, Naik 
SB: 
Clinical efficacy of subgingivally delivered 1.2% atorvastatin in chronic periodontitis: 
a randomized controlledclinical trial. J Periodontol. 84(7):871-9. 2013. 
 
- Rivera 
C, Monsalve 
F, Salas 
J, Morán 
A, Suazo 
I: Platelet 
rich plasma, plasma rich in growth factors and simvastatin in 
the 
regeneration and repair of alveolar bone. Exp Ther Med. 6(6):1543-1549. 2013. 
 
- Sato D, Nishimura K, Ishioka T, Kondo H , Kuroda S, aka sugar S: Local application of 
simvastatin to rat incisor socket. Carrier- dependent effect on bone augmentation. J oral 
tissue Engin; 2(2): 81-85. 2005. 
 
- Schropp L, Wenzel A, Kostopoulos L, Karring T: Bone healing and soft tissue contour 
changes following single-tooth extraction: a clinical and radiographic 12-month 
prospective study. Int J Periodontics Restorative Dent; 23(4):313–23. 2003. 
 
- Sotiriou CG, Cheng JW: Beneficial effects of statins in coronary artery disease Beyond 
lowering cholesterol. Ann Pharmacother. 34:1432-1439. 2000. 
 
- Staal A,Frith JC,French MH: The ability of statins to inhibit bone resorption is directly 
related to their inhibitory effect on HMG-CoA reductase activity. J Bone Miner Res. 
18:88-96. 2003. 
 
- Trombelli L, Farina R, Marzola A, Bozzi L, Liljenberg  B, Lindhe J:Modeling and 
remodeling of human extraction sockets. Journal of Clinical Periodontology; 35 (7): 630–
639, 2008. 
 
- Terblanche M, Almog Y, Rosenson RS, Smith TS, Hackam DG: Statins and sepsis: 
Multiple modifications at multiple levels. Lancet Infect Dis. 7:358-368. 2007. 
 
- Ulm C, Solar P, Blahout R, Matejka M, Gruber H: Reduction of the compact and 
cancellous bone substances of the edentulous mandible caused by resorption. Oral Surg 
Oral Med Oral Pathol; 74(2):131–6. 1992. 
 
- Wang JW, Xu SW, Yang DS and Lv RK: Locally applied simvastatin promotes fracture 
healing in ovariectomized rat. Osteoporosis Int. 18: 1641-1650. 2007. 
 
 

 
12 
 
 
 
 
 
 
 
 
 
 
 
 
تذعين هكاى ها بعذ الخلع باستخذام دواء األتىرفاستاتيي الوحوّل على هيكل الفيبريي 
هي البالزها الغٌية بعىاهل الٌوى:دراسة إكليٌيكية و تحليل هيستىلىجي 
 
ِمذِخ 
ِٓ
 اٌطجٍجخ 
ًهى ًصر دمحم السلباًي 
ثىبٌٛسٌٛط غت 
ُاٌف ٚ 
ْاألعٕب 
خبِؼخ 
ٍٓػ شّظ
٢٠٠٦  
ٌٍحصٛي ػٍى دسخخ اٌّبخغزٍش 
ًف غت 
ُاٌف ٚ ػالج اٌٍثخ ٚ اٌزشخٍص 
حذ ر إششاف 
أ.د/ خالذ عبذ الغفار 
أعزبر غت 
ُاٌف ٚ اٌزشخٍص ٚػالج اٌٍثخ  
ٚ ػٍّذ وٍٍخ غت 
ْاألعٕب -خبِؼخ 
ٍٓػ شّظ 
 
أ.د/ايهاب سعيدعبد الحميد ابراهيم 
 
أستبذ ببثولوجيب الفم ووكيل الكلية لشئون الدراسبت العليب  
بكلية طب األسنبن- جبمعة عيه شمس 
 
د/عال دمحم عست 
ِذسط غت 
ُاٌف ٚ ػالج اٌٍثخ ٚ اٌزشخٍص 
وٍٍخ غت 
ْاألعٕب -خبِؼخ 
ٍٓػ شّظ 
 
 

 
13 
وٍٍخ غت 
ْاألعٕب 
خبِؼخ 
ٍٓػ شّظ 
٢٠٠٦ 
 
 
 
 
 
 
 
 
 
اٌٍّخص 
ًاٌؼشث 
اٌّمذِخ 
رؼذ صساػخ 
ْاألعٕب 
ِٓ
 
ًأفع اٌحٍٛي العزجذاي 
ْاألعٕب 
ًاٌز ال ػالج ٌٙب اال اٌخٍغ ٚ ِب ٌٕزح 
ٓػ اٌخٍغ 
ِٓ
 
ًِشبو 
ارا رشن 
ِْىب اٌخٍغ 
ْٚثذ 
ٍِٗئ 
ٓػ غشٌك ٚظغ أٌب 
ِٓ
 ِشزمبد اٌجالصِب 
ًِث اٌجالصِب اٌغٍٕخ 
ًِثؼٛا 
ٌّٕٛا  
ٚا 
خضٌئبد 
ُاٌؼظ 
ٚا دٚاء 
ًِث دٚاء 
ٍٓاالرٛسفبعزبر  ِّب 
ٌّٓحغ حبٌخ 
ًاٌزؼبف 
ِٓ
 اٌخٍغ ٚ ٌٍٙئ 
ْاٌّىب العزمجبي 
صساػخ 
ْاألعٕب ثصٛسح 
ٓرحغ إٌزبئح اٌّشخٛح 
ِٓ
 خٛدح ٚ عشػخ 
ُاٌؼظ 
ْٛاٌّزى ثؼذ 
ْثّب أعبثٍغ 
ِٓ
 اٌخٍغ ثذال 
ِٓ
 عزخ أشٙش ٚ 
ٛ٘
 اٌٛلذ اٌّزٛلغ 
ٌْٛزى 
ُػظ خذٌذ 
ًف 
ِْىب اٌخٍغ ِّب ٌٛفش اٌٛلذ ٚ 
ٌَخذ ِصٍحخ اٌّشٌط . 
     ٌزٌه االدٌٚخ 
ِٓ
 ِدّٛػخ 
ٍٓاٌغزبر ٚ 
ً٘
 أدٌٚخ 
ًٍرم اٌىٌٍٛغزٍشٚي 
ًف 
َاٌذ ُٚ ٚخذ 
ْا ٌٙب رأثٍشا إٌدبثٍب 
ًف 
ػالج  
ِْىب اٌخٍغ ٌّب ٚخذ ٌٙب 
ِٓ
 ػذح فٛائذ 
ًِث ِعبدح ٌالٌزٙبة ٚ ِعبدح ٌألوغذح ٚصٌبدح اٌجشٚرٍٕبد اٌؼظٍّخ 
اٌّزؼذدح 
ٓػ غشٌك رحفٍض اٌخالٌب 
َاال  ػٍى اٌزحٛي ٌخالٌب ثٕبء 
ُاٌؼظ ٚ رغبػذ ػٍى اٌزىٍظ ٚ ٌٙب رأثٍش 
ًٌٍم ٔشبغ 
اٌخالٌب األوٍخ 
ٌٍُؼظ. 
اٌجالصِب اٌغٍٕخ 
ًِثؼٛا 
ٌّٕٛا 
َثبعزخذا وٍٛسٌذ 
ٍَٛاٌىبٌغ 
ْ ّٛرى 
ًٍ٘ى 
ِٓ
 أٌٍبف 
ٌٓاٌفٍجش اٌزي شبع 
ِٗاعزخذا 
وّغبػذ ٌزدذٌذ األٔغدخ ٚ 
ًٌٍم اٌّعبػفبد 
ًِث االٌزٙبة ٚ 
ٌُاأل. 
ُثبٌشغ 
ِٓ
 ٌا
ذساعبد اٌّزؼذدح 
ٓػ أٍّ٘خ 
ًو 
ِٓ
 أدٌٚخ 
ٍٓاٌغزبر ، 
ًأٍٚ٘ى 
ٌٓاٌفٍجش اٌّشزك 
ِٓ
 اٌجالصِب اٌغٍٕخ 
ًِثؼٛا 
ٌّٕٛا 
ٍٍِٕٓفص ، ال رٛخذ دساعبد وبفٍخ 
ٓػ 
ٖرأثٍش 
ًِّح 
ًٍػ 
ًٍ٘ى 
ٌٓاٌفٍجش ٚ ٌٙزا رٙذف 
ٖ٘ز اٌذساعخ 
ٌّمبسٔخ إٌزبئح ثؼذ 
َاعزخذا دٚاء 
ٍٓاالرٛسفبعزبر  
ًّاٌّح ػٍى 
ًٍ٘ى 
ٌٓاٌفٍجش اٌّشزك 
ِٓ
 اٌجالصِب اٌغٍٕخ 
ًِثؼٛا 

 
14 
،ٌّٕٛا ٚ دٚاء 
ٍٓاالرٛسفبعزبر 
ًّاٌّح ػٍى 
ًخ 
ًٍاٌٍّث عٍٍٍٍٛص ٚ 
ُِٙمبسٔز 
َثؼذ ٚظغ اي شئ 
ِْىب اٌخٍغ ٚ رٌه 
ٓػ غشٌك اٌمٍبعبد اٌفؼٍٍخ ٌطٛي ٚ ػشض 
ُاٌؼظ 
ًلج اٌخٍغ ٚ ثؼذ اٌخٍغ ٚ 
ٓػ غشٌك 
ًٍٍرح ػٍٕخ 
ُاٌؼظ اٌّأخٛرح 
ثؼذ اٌخٍغ ثثّْب أعبثٍغ أثٕبء ػٍٍّخصسع 
ٓاٌغ اٌدذٌذح . 
اٌّشظى ٚ اٌطشق:
 
ُعٍز إخشاء اٌذساعخ اٌحبٌٍخ ػٍى ِدّٛع ٠٠
شخص 
ِٓ
 
ٍٓاٌدٕغ 
ًٍػ 
ْا 
ٌْٛى 
ٌٌُٙذ 
ْاعٕب ٌٍظ ٌٙب ػالج اال 
اٌخٍغ ٚ 
ُعٍز 
ٍُرمغ 
ٖ٘ز اٌّٛالغ ػشٛائٍب  إٌى ٠
ِدّٛػبد. ٚاٌّدّٛػخ االٌٚى 
ُعزع ٠٠ ِٛالغ ثؼذ اٌخٍغ 
ٌُز 
ٍِئٙب  ثذٚاء 
ٍٓاالرٛسفبعزبر 
ًّاٌّح 
ًٍػ اٌجالصِب اٌغٍٕخ 
ًِثؼٛا 
ٌّٕٛا ٚاٌّدّٛػخ اٌثبٍٔخ 
ُعزع ٠٠ ِٛالغ ثؼذ 
اٌخٍغ  
ٌُز ٍِئٙب ثذٚاء 
ٍٓاالرٛسفبعزبر 
ًّاٌّح 
ًٍػ 
ًخ 
ًٍاٌٍّث عٍٍٍٍٛص ٚ ٚ اٌّدّٛػخ 
ُاٌثبٌثخعزع ٠٠ ِٛالغ 
ُعٍز اٌخٍغ 
ْٚثذ ًِء 
ِْىب ثؼذ اٌخٍغ ثبي شئ . 
ُعٍز 
ًّػ ٍل
بعبد اوٍٍٍٕىٍخ السرفبع ٚ ػشض 
ُاٌؼع 
ِْىب اٌخٍغ 
ًلج اٌؼالخبد ٚ ٨ ثؼذ اعبثٍغ وّب 
ُعٍز  أخز 
ػٍٕبد 
ِٓ
 
ُاٌؼظ 
ْٛاٌّزى ثؼذ 
ْثّب أعبثٍغ ثؼذ ػٍٍّخ اٌخٍغ ٚ رحٍٍٍٙب ٍ٘غزٌٛٛخٍب رحذ اٌٍّىشٚعىٛة ٚ 
ُعٍز 
رؼٌٛط 
ٓاٌغ اٌّخٍٛػخ 
ٓػ غشٌك ػٍٍّخ صساػخ 
ٓع ثذٌٍخ 
ًف ٔفظ اٌضٌبسح ثؼذ ز أخ اٌؼٍٕخ. 
ُعٍز خّغ إٌزبئح ٚ رحٍٍٍٙب احصبئٍب