Review Article

Contribution of Statins towards Periodontal Treatment: A Review

Table 4

In vivo studies evaluating the impact of systemic statin administration on periodontal wound healing.

Systemic drug delivery
ReferenceExperimental periodontitis induction model
(i) Animal
(ii) Method
(iii) Site
Periodontitis treatment
(i) Type of treatment
(ii) Type and dose of statin
(iii) Mode and time of statin delivery
ResultsPeriodontal considerations

[31]Rats (male)
EIP by ligatures
Maxillary left M2
Nonsurgical treatment (protective)
Atorvastatin
1 mg/kg, 5 mg/kg, and 10 mg/kg
1 hour before induction and thereafter once daily
↘ MMP-2, MMP-9
↘ RANK-L, RANK
↗ OPG
↗ GSH levels
↘ IL-1β, TNF-α, and MPO (dose dependent)
↘ COX-2 level
↘ MDA activity
↘ alveolar bone loss is dose dependent
Atorvastatin protected against alveolar bone loss in a dose-dependent manner

[58]Rats (female)
EIP by ligatures
Maxillary left M2
Nonsurgical treatment (protective)
Simvastatin 3, 10, and 30 mg/kg/day
1 hour before induction and thereafter once daily
↗ BMP-2 and OPG levels
↗ TRAP activity
↘ MPO activity (dose dependent)
↘ IL-1β and TNF-α
↗ IL-10
↘ gingival GSH
↗ gingival MDA and NOX
↘ iNOS, MMP-1, MMP-8, RANK, and RANKL expression
No differences in AST and ALT levels
Inhibition of alveolar bone loss
Simvastatin prevented inflammatory bone resorption and possessed antioxidant properties

[144]Rats (male)
EIP by ligatures
Maxillary left M2
Nonsurgical treatment (protective)
Atorvastatin
1, 3, and 9 mg/kg
Atorvastatin mixed in sterile saline by gavage
30 min before ligature placement and then daily until euthanasia
↘ alveolar bone loss
in the furcation area as well as in proximal faces of upper M2
(47% reduction with 9 mg dose compared to that with the control)
Insignificant bone loss protection with 1 and 3 mg doses
Atorvastatin had protective effect against alveolar bone loss

[40]Rats (male)
EIP by ligatures
Maxillary left M2
Nonsurgical treatment (protective + therapeutic)
Atorvastatin 0.3 mg/kg or 27 mg/kg by gavage
In combination with ALN
30 min before ligature placement and thereafter once daily until euthanasia or 5 days after the start of periodontitis induction and then daily until euthanasia
↘ TRAP and MPO activity
↘ cementum resorption
↘ neutrophilia and lymphomonocytosis
↘ alveolar bone loss both prophylactically (39%) and therapeutically (53.4%) with lower dose of (0.01 mg/kg+0.3 mg/kg, respectively)
Prevented BALP reduction with lower dose of
No effect on serum transaminases
Atorvastatin reduced alveolar bone loss, cemental resorption, and inflammatory cell infiltration both prophylactically and therapeutically

[145]Rats (male)
EIP by ligatures
Maxillary left M2
Nonsurgical treatment (protective)
Atorvastatin 0.3, 3, and 27 mg/kg by gavage
30 min before ligature placement and thereafter once daily until euthanasia
↘ alveolar bone in a dose-dependent manner (39% for 3 mg/kg and 56% for 27 mg/kg doses)
Prevented the reduction of BALP serum levels (27 mg/kg)
Prevented leukocytosis (27 mg/kg)
Atorvastatin prevented alveolar bone loss with both prophylactic and therapeutic doses

[32]Rats (female with metabolic syndrome)
ACP (injection of 20 μg of A.a LPS in PBS) into the palatal gingiva between the maxillary M1 and M2, thrice per week for 4 weeks
Nonsurgical treatment (protective)
Simvastatin 20 mg/kg/day
Daily via gavage for 4 weeks
Treatment started on the same day as injection of LPS
↘ LPS induced alveolar bone loss in both lean and fat rats (significantly)
↘ infiltration of mononuclear cells
↘ inflammatory score
↘ LPS stimulated RANKL and CSF2 expression in both lean and fat rats
↘ bone resorption
Simvastatin downregulated inflammation-mediated bone resorption

[33]Rats (female)
ACP injection of 20 μg/rat of A.a
LPS through the palatal gingiva between the maxillary M1 and M2 thrice per week for 8 weeks
Nonsurgical treatment (protective)
Simvastatin (20 mg/kg/day) daily via oral gavage for 8 weeks
↘ LPS induced alveolar bone loss (31%)
↘ LPS induced osteoclastogenesis
↘ TNF-α, IL-1α, IL-1β, IL-6, CSF-2, CSF-3, MCP-1, and MMP-9
↘ LPS induced TLR family members’ expression
Simvastatin downregulated inflammation-mediated bone resorption

[25]Rats (male)
EIP by ligatures
Maxillary M2
Nonsurgical treatment (protective)
Rosuvastatin
20 mg/kg in water by gavage
1 h before ligation and then once daily until euthanasia
↗ IL-10
↘ IL-1β
↗ MDA
↗ GSH
↘ inflammatory infiltrate
↘ OC number
↗ OB number
↘ alveolar bone loss (significantly)
Rosuvastatin protected against alveolar bone loss

[54]Rats (male)
EIP by ligatures
Hyperlipidemia induction through diet
Maxillary M2
Nonsurgical treatment (protective)
Rosuvastatin
20 mg/kg in water by gavage
1 h before ligation and then once daily until euthanasia
↘ gingival iNOS (significantly)
↘ inflammation and hyperemia
↘ alveolar bone loss
Rosuvastatin protected against inflammation-induced bone degradation

[34]Rats (male)
EIP by ligatures
Mandibular M1 and maxillary M2 bilaterally
Nonsurgical treatment (therapeutic)
Simvastatin
10 mg/kg in water once daily orally until euthanasia
Treatment started 8 days after periodontitis induction
↘ alveolar bone loss
↘ IL-6
↘ CRP
Simvastatin decreased inflammation and alveolar bone loss

[93]Rats (male hypertensive)
EIP by ligatures
Mandibular M1 bilaterally
Nonsurgical treatment (protective)
Rosuvastatin
2 mg/kg oral gavage
Treatment started since the day of induction daily until euthanasia
↘ bone loss in furcation area
↘ attachment loss
↘ TRAP-positive multinucleated cells
Rosuvastatin reduced alveolar bone loss and osteoclastogenesis

[97]Rats
EIP by ligatures
Mandibular M1
Nonsurgical treatment (protective + therapeutic)
Simvastatin
Different treatments: simvastatin-simvastatin: aqueous suspension of simvastatin by gavage (35 mg/kg/day) administration before and after periodontitis induction; simvastatin-water: simvastatin administration before and filtered water after periodontitis induction; and water-simvastatin: water administration before and simvastatin after periodontitis induction
No significant differences between groups receiving simvastatin before the induction of periodontitis and those that received water
No protective effect of simvastatin against the development of periodontitis
Simvastatin did not possess protective or therapeutic effects against periodontitis development

[146]Rats (male)
EIP by ligatures
Mandibular left M1
Nonsurgical treatment (therapeutic)
Simvastatin 25 mg/kg
Dissolved in saline
Treatment started 14 days after the initiation of periodontitis induction
↗ TG levels
↘ MDA level
↗ IL-10
↘ MMP-9
↘ bone loss
No difference on TNF-α levels
Simvastatin promoted the anti-inflammatory mediators to counter alveolar bone loss

[35]Rats (male, cyclosporine A-induced alveolar bone loss)
EIP by ligatures
Mandibular right M1
Nonsurgical treatment (protective)
Simvastatin
20 mg/kg orally daily
for 30 days
The treatment and induction started on the same day
↗ Ca2+ concentrations (significantly)
No effect of simvastatin treatment in the presence of periodontal disease on serum ALP levels but it blocked the cyclosporine A-mediated decrease of ALP
No significant effect on alveolar bone turnover but with concomitant cyclosporine A and simvastatin delivery
Simvastatin completely inhibited cyclosporine A-induced bone loss
Simvastatin did not prevent alveolar bone loss in periodontitis but it completely countered the cyclosporine A-induced bone loss

[147]Rats (male)
EIP by ligatures
Mandibular right M1
Nonsurgical treatment (protective)
Simvastatin
20 mg/kg
The treatment and induction started on the same day
↗ ALP activity in periodontal inflammation
↘ alveolar bone loss
Simvastatin protected against alveolar bone loss

[76]Mice (male)
ACP (P.g LPS injection)
1 mg/kg P.g LPS
injection at the gingiva of left mandibular M2 on days 4 and 7
Nonsurgical treatment (protective)
Fluvastatin 3 mg/kg
IP injections on days 1, 4, and 7
↘ LPS induced OC (by >50%)
↘ LPS-induced bone erosion
↘ RANKL
Fluvastatin prevented inflammation-induced bone erosion

[26]Rats (male, GIOP)
EIP by ligatures Maxillary left M2
Nonsurgical treatment (protective)
Atorvastatin
27 mg/kg ATV orally
30 min before induction and once daily afterwards
↘ bone loss
↘ MPO, TNF-α, IL-1β, IL-6, and IL-8
↗ IL-10, GSH, SOD, and CAT levels
↘ RANKL and DKK-1
↗ OPG, WNT10 β, and β-catenin expressions and BALP activity
Atorvastatin prevented alveolar bone loss in periodontitis and reduced inflammation