الفهرس 
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Abstract
Treatment of periodontitis is targeted mainly towards the reduction of pathogens present in the subgingival biofilm. Non-surgical periodontal therapy (NSPT) includes the improvement of oral hygiene and the use of subgingival scaling and roots surface debridement for removing the soft and calcified biofilm deposits from the affected root surfaces. Although NSPT is considered the gold standard of periodontal treatment, there were some limitations necessitate the adjunctive use of locally chemotherapeutic agents.
The rationale for using locally delivered drugs (LDD) in periodontal disease is to chemically kill or reduce the plaques within the biofilm in the pocket. This is achieved by applying high concentrations of an antibiotic or antiseptic in direct contact with the root surface without remarkable systemic effect, which may not be always possible with systemic antibiotics.
Aside from that statins have lipid-lowering properties, they also possess potential pleiotropic effects such as host modulation and bone regeneration which seem to be beneficial in periodontics.
They inhibit the release of pro-inflammatory cytokines such as IFN-γ, TNF-α, IL-1β, and IL-6 thereby providing immune-modulatory effects as well. Statins also cause inhibition of NADPH thereby providing an antioxidant effect, as well as angiogenesis promotion. Locally delivered SMV leads to increase the osteoblast differentiation, inducing bone formation. SMV can suppress the activation of NF- κB and prevent the binding of RANK/RANKL. Thus inhibition of osteoclast activity and bone resorption.
Lepidium sativum (LS) is an annual herb that grows quickly originating in Egypt and West Asia. Its seeds are highly composed of protein, omega-3 fatty acids, dietary fiber, phytochemicals, iron, and other essential nutrients. LS has been given different names such as Garden cress, Habul Rashad, and Thuffa.
LS seed oil primarily consists of α-linolenic acid (ALA) (32 %) linoleic acid (LA) (11.82%). Due to its high antioxidant, this oil is re¬actively stable and can be used in inflammatory diseases including periodontitis. There is a study revealed that the extract significantly down-regulated the pro-inflammatory cytokines (such as IL-1β, TNF-α, and IL-6), stress genes (as iNOS), and up-regulated the IL-10 expression dose-dependently. Moreover, LS leads to down-regulation of NF-κB and NO levels.
In addition, LS is used commonly to treat inflammatory diseases such as hepatitis, diabetes mellitus and arthritis. LS has antidiarrheal, antioxidant, antispasmodic, hepa¬to-protective, anti-inflammatory, and antimicrobial effects.
The objective of the present study was to assess and compare the efficacy of locally delivered LSE gel and SMV gel on the clinical parameters and on the level of NF- κB as an adjunct to non-surgical periodontal therapy in the treatment of localized stage (II and/or III), grade (A) periodontitis.
Patients were divided into two groups; group (I) included 15 patients treated with scaling and RSD followed by local application of LS gel. group (II) included 15 patients treated with scaling and RSD followed by local application SMV gel.
Clinical parameters including PI, MSBI, PD, and CAL were recorded at baseline and after 3 months follow-up period. Furthermore, GCF sample collection was done using perio-paper strips for biochemical assessment. It was done at baseline, one month and three months postoperatively.
Results showed resolution of gingival inflammation, reduction in PD, and gain in CAL after 3 months. However, there is no statistically significant difference between the test and control group regarding these clinical parameters.
Regarding biochemical analysis, there was a statistically significant decrease in the mean percentage change of NF- κB level (ng/ml) in both groups. The difference between the two studied groups was insignificant at the time interval (from baseline to 3 months).
In conclusion of all of the above and within the limitations to the current study, LS in situ gel had a beneficial therapeutic effect on both clinical and biochemical parameters of periodontitis in adjunct to NSPT. For the future work we should conduct more research studies that include larger groups and a longer follow up periods. Also, more studies should be performed to investigate the application of the gel more than once using different concentrations.