الفهرس | Only 14 pages are availabe for public view |
Abstract Periodontitis is an inflammatory disease of the supporting tissues of the teeth, caused by a group of specific microorganisms, Periodontitis can result in bone resorption creating bony defects, which may cause tooth loss. Several treatment procedures have been studied to achieve periodontal regeneration. A critical step in periodontal regenerative therapy is to alter the periodontitis affected root surface to make it a hospitable substrate, to support and encourage migration, attachment, proliferation and proper phenotypic expression of periodontal connective tissue progenitor cells. So the Concept of EDTA root modification or alteration of the root surface has emerged as a potential therapeutic approach to the reconstruction of the periodontal unit. Pharmacological agents offer also great promise in this direction. Atorvastatin, used for the treatment of hypercholesterolemia, is a universally accepted and relatively inexpensive drug. Application of Atorvastatin has been shown to stimulate bone formation. It is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Recently, statins have shown pleiotropic effects such as anti-inflammation and bone stimulation, these effects seem to be associated with an increased expression of BMP-2 and reduced formation of metabolites of the mevalonate pathway. Enamel matrix derivative (EMD) is a commercially available protein extract, mainly comprising amelogenins. A number of other polypeptides have been identified in EMD, mostly growth factors, which promote cementogenesis and osteogenesis during the regeneration processes through the regulation of cell proliferation, differentiation and activity; however, not all of their functions are clear. Enamel extracts have been proposed to have numerous activities such as bone morphogenetic protein. This study was performed to evaluate the clinical effectiveness of Atorvastatin gel compared to enamel matrix derivative as adjunct to open flap debridement in management of intrabony defects in chronic periodontitis, and to investigate concentrations of Gingival cervicular fluid (GCF) bone morphogenic protein-2 (BMP-2) level during the early stages of healing for sites treated. Eighteen patients with chronic periodontal disease, were randomly treated with a combination of either (ATV+b-TCP) or (EMD + b-TCP) or with only b-TCP EDTA application on root surface. Clinical evaluation was performed at baseline and 3, 6 months following therapy. Clinical findings of present study revealed improvement in clinical and radiographic parameter in all groups after 3 and six months. The difference between baseline and 3 months and between three and six months were significant regarding (PD, CAL) in each group, comparison between groups at 3 months and at 6 months revealed significant differences in all groups regarding PD & CAL. The results of the study showed the highest BMP-2 levels in samples of day 7 and 14 respectively followed by decreased levels in day 21 samples for both GroupI, III, while in group II continue to increase to day 21, with no statistical significant differences between times interval regarding BMP-2 among group I, II, III. This sustained level of BMP-2 reported with EMD treated group could be attributed to the EMD carrier amelogenins who allowed for more EMD substantivity. Further investigations on possible low cost effective carrier with space maintaining properties for ATV are recommended for its further use in intrabony defects. |