الفهرس 
Page no. INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Periodontitis can be defines as “An infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment, and bone loss. It is characterized by pocket formation and/or gingival recession.”
Periodontal treatment should result in inflammation elimination, stop periodontal disease progression, enhance esthetics and produce an environment which is useful to maintain periodontal health. Firstly, non surgical periodontal therapy (NSPT) is the keystone of periodontal treatment and the primary approach suggested for the management of periodontal infections.
Pharmacotherapeutics may have an adjunctive role in the management of periodontitis either to slow the progression of the diseases or to improve periodontal status in certain patients. Local application into periodontal pocket could be very advantageous, both in terms of rising drug concentration directly in the action site, preventing systemic side effects, and facilitating prolonged and controlled drug delivery to improve clinical signs of periodontitis.
In the present study two different forms of drug delivery system were utilized. The first delivery system is the in situ implant system which is an Injectable liquid preparation that is
injected intramuscular or subcutaneous then solidified in site (in situ) to develop a solid or semi solid store of the drug, which have been established as an adjustable substitute for the parenteral controlled delivery of the therapeutic agent. The second system used is methylcellulose gel. Methylcellulose is broadly utilized of topical and oral pharmaceutical preparations.
Statins are types of drugs used in treatment of high
cholesterol level by decreasing levels of hydroxy‐methyl‐glutaryl co‐enzyme A reductase that cause reduction of the mevalonate
pathway, which has to be included in the production of cholesterol in the liver.
Statins can also induce angiogenesis by inducing production
of vascular‐endothelial growth factor and osteogensis by inducing production of bone morphogenetic protein‐2 (BMP‐2), and inhibit
the activator receptors of nuclear factor κB and its ligand
(RANK‐RANKL). It was found that in patients treated with
statins there were increased serum levels of osteoprotegerin
levels, inhibition of osteoclasts (decreasing bone resorption) and inhibition of activities of il-6, C reactive protein, adhesion molecules and reactive oxygen species (anti inflammatory effect).
In this study, it was hypothesized that in situ forming implant is a better delivery system for statins in periodontal pockets
compared to the commonly used methylcellulose gel as it has greater advantages which include the ease administration of the drug, reasonable cost and it could be placed easily into periodontal pockets using a syringe. Poly-(dl-lactide-co- glycolide) (PLGA) was used as it has low toxicity and is biodegradable.
So, this study was performed to investigate the clinical and radiographic effectiveness of local application of 1.2mg simvastatin delivered in in situ forming implant system and methylcellulose gel as an adjunct to periodontal debridement in the treatment of severe chronic periodontitis, and to monitor the drug release profile into the gingival crevicular fluid using periopaper to collect GCF samples over 18 days period of time.
Both groups showed significant improvement in clinical parameters, radiographic bone fill after 6 months of follow up, with a percentage of change of probing depth and in CAL gain in group I (sim/gel) (-31.10%) and (-31.73) in group II (sim/insitu) and percentage of radiographic bone fill of (20.55%) in group I (sim/gel) and (19.82%) in group II (sim/insitu).
On comparing the mean concentration of the drug in GCF in group II (sim/insitu) it showed higher values than in group I (sim/gel), also the group II (sim/insitu) (with mean % change value of (7.34%) showed more sustained release than
methylcellulose gel in group I (sim/gel) (with mean % change value of (-9.45%)