Graduation Date

Summer 8-13-2021

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Richard Reinhardt, D.D.S., Ph.D

Second Advisor

Amy Killeen, D.D.S., M.S.

Third Advisor

Ali Nawshad, Ph.D.

Fourth Advisor

James Wahl III, Ph.D.

Abstract

The purpose of this analysis of inflammation markers from a double blinded, randomized, controlled clinical trial was to determine if local application of simvastatin, combined with minimally invasive papilla reflection/root preparation (PR/RP) is effective in reducing markers of inflammation: 1) bleeding upon probing (BOP), 2) tissue inflammatory / anti-inflammatory gene activation (rt-PCR) and 3) corresponding gingival crevicular fluid (GCF) protein production in non-resolving 6-9 mm periodontal pockets in patients on periodontal maintenance therapy (PMT). Fifty periodontal maintenance patients diagnosed with advanced chronic adult periodontitis presenting with a 6-9 mm interproximal PD were included in study. Experimental (PR/RP+SIM; n=27) and control (PR/RP+S, n=23) therapies were randomly allocated. Inflammation was assessed by bleeding upon probing (BOP) at baseline and 12-months and gingival crevicular fluid (GCF) samples at baseline, 2-weeks, and 12-months. To assess gene activation (RT-PCR), an approximately 2x2x2 mm piece of gingival connective tissue was harvested and assessed at baseline and 2-weeks postoperative therapy. Scaling and root planing with papilla reflection in inflamed, persistent, deep periodontal pockets during PMT with the addition of SIM, resulted in clinical improvements in BOP after 12-months. GCF Il-6 and VEGF were significantly elevated at 2-weeks wound healing, and an increase in 2-week GCF IL-10 was significantly correlated with improved CAL (r=-0.32, p=0.03), and rt-PCR raw values were numerically higher in SIM group at 2-weeks for IL-6, RANKL and IGF-1.

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