الفهرس 
REVIEW OF LITERATURE
Biological mediatorsOnly 14 pages are availabe for public view
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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.