Mediators of Inflammation

Review Article

Contribution of Statins towards Periodontal Treatment: A Review

Table 6

Clinical studies evaluating the impact of local statin administration on periodontal wound healing.
Local drug delivery
Reference
Study area
Type of study		Drug
Mode of delivery
Dose		Number of patients
Periodontal status
Type of patients		Type of treatment
Study design (groups)
Follow-up		ResultsPeriodontal considerations
[130] (India)
RCT with split-mouth design		Simvastatin in methylcellulose gel
1.2 g of SIM		30
Periodontitis (Armitage 1999)
Healthy patients (nonsmokers)
Sites with periodontal pocket and vertical bone in different quadrants of the mouth		Nonsurgical treatment
Group I: gel
Group II: gel
6 months follow-up		All subjects tolerated the drug
↗ periodontal parameters with or without SIM
↗ CAL ()
↗ INFRA 2 ()
↘ PD significantly ()
↘ INFRA 1 ()		Simvastatin increased periodontal regeneration and CAL gain
[23] (India)
RCT		Rosuvastatin
1.2% rosuvastatin (RSV) gel		90
Chronic periodontitis
Healthy patients (nonsmokers)		Nonsurgical treatment
Groups I: gel
Group II: RSV gel
Group III: MF gel
12 months follow-up		↗ CAL
↘ PD significant
↗ bone fill
↘ PI
↘ mSBI
↘ DDR		Rosuvastatin increased periodontal regeneration and CAL gain
[102] (India)
RCT		Atorvastatin and rosuvastatin
1.2% atorvastatin or 1.2% rosuvastatin gel local drug delivery
(1.2 mg/0.1 mL)		90
No data
Healthy patients (nonsmokers)
Mandibular class II furcation defects with and horizontal 		Nonsurgical treatment
Group I:
Group II: RSV gel
Group III: ATV gel
9 month follow-up		↘ PI and mSBI in all groups
The 2 statins lead to the following:
↘ PD
↗ mean gain in CAL
↗ mean percentage of DDR
Statistically greater results for RSV than for ATV		Statins increased periodontal regeneration and CAL gain
[103] (India)
Cohort study		Simvastatin
SIM gel (1.2 mg/0.1 mL)		50
Chronic periodontitis
Healthy patients (nonsmokers)		Nonsurgical treatment
Group I: SRP alone
Group II: gel
3 months follow-up		↘ IL-6 and IL-8
↗ IL-10 significantly
↘ PI, mSBI, and PD
No effect on CAL		Simvastatin gel decreased periodontal inflammation and promote periodontal regeneration
[21] (India)
RCT		Simvastatin
1.2% simvastatin gel		46
Chronic periodontitis
Healthy patients (nonsmokers)		Nonsurgical treatment
Group I: SRP
Group II: gel
45 days follow-up		↘ PI, GI, and SBI
No significant difference for PD and CAL
↘ mean IL-6 levels
No significant difference for IL-8 levels		Simvastatin gel decreased periodontal inflammation
[104] (India)
Cohort study with split-mouth design		Simvastatin
Combination of DFDBA and a 10−8 M solution of the drug simvastatin		15
No data
Healthy patients (nonsmokers)
Identical bilateral infrabony defect		Surgical treatment (Kirkland flap)
Group A: DFDBA alone
Group B:
24 weeks follow-up		↘ PD
↗ mean gain in CAL (better with )
↘ infrabony defect depth (greater reduction with )
↗ linear defect fill (better with )		Simvastatin increased periodontal regeneration and CAL gain
[148] (India)
RCT		Atorvastatin
1.2% atorvastatin gel (ATV gel (1.2 mg/0.1 mL)		75
Well-controlled type 2 diabetic patients (nonsmokers)
Chronic periodontitis		Nonsurgical treatment
Group 1:
Group 2:
9 months follow-up		↗ mSBI
↘ PD
↗ CAL gain
↘ IBD depth and DDR
No significant difference for PI at all time intervals evaluated		Atorvastatin increased periodontal regeneration
[125] (India)
RCT		Atorvastatin
1.2% atorvastatin gel (ATV gel (1.2 mg/0.1 mL))		71
Smokers
Chronic periodontitis		Nonsurgical treatment
Group 1:
Group 2:
9 months follow-up		↘ PD
↗ mean CAL gain
↘ mean percentage of DDR
↘ mSBI
↘ IBD depth
No statistically significant difference in the site-specific PI score and full-mouth PI score between the groups at any visit		Atorvastatin increased periodontal regeneration and CAL gain
[105] (India)
Cohort		Atorvastatin
1.2% ATV gel		96
Healthy patients (nonsmokers)
Chronic periodontitis		Surgical treatment
Group I:
Group II: ATV
Group III: OFD alone
9 months follow-up		ATV gel and PRF alone showed significantly the following:
↘ PD
↗ mean CAL gain
↘ IBD depth
No statistically significant difference in PI and mSBI scores between the groups at 9 months		Atorvastatin increased periodontal regeneration and CAL gain
[101] (India)
RCT		Atorvastatin and simvastatin
10 mL of 1.2% ATV gel (1.2 mg/0.1 mL) and 10 mL of 1.2% SIM gel (1.2 mg/0.1 mL)		96
Healthy patients (nonsmokers)
Chronic periodontitis		Nonsurgical treatment
Group I: ATV
Group II: SIM
Group III:
9 months follow-up		The 2 statins lead to the following:
↘ PD
↘ mSBI
↘ IBD depth
↗ mean CAL gain
Statistically greater results for ATV than for SIM for PD reduction, CAL gain and percentage of IBD reduction		Atorvastatin increased periodontal regeneration and CAL gain
[149] (India)
RCT		Simvastatin
Single topical transmucosal injection 1.2 mg SIM		60
Chronic periodontitis
Healthy patients (nonsmokers)		Nonsurgical treatment
Group I:
Group II:
6 months follow-up		↘ mSBI
↘ mean PD
↗ mean CAL
↗ IBD fill
↘ GI		Simvastatin increased periodontal regeneration and CAL gain
[126] (India)
RCT		Simvastatin
SIM 1.2 μg/inj. (0.12 μg/mm3)
Methylcellulose gel		72
Chronic periodontitis
Healthy patients (nonsmokers)
Mandibular buccal class II furcation defects		Nonsurgical treatment
Group I:
Group II: SIM
6 months follow-up		↘ SBI and PB
↗ CAL
↗ IBD fill		Simvastatin increased periodontal regeneration and CAL gain
[150] (India)
RCT		Atorvastatin
1.2% ATV methyl cellulose gel		60 patients
Chronic periodontitis
Healthy patients (nonsmokers)		Nonsurgical treatment
Group I: ATV
Groups II: gel
9 months follow-up		↘ PD
↘ mSBI
↗ mean CAL gain
↗ IBD fill		Simvastatin increased periodontal regeneration and CAL gain
[151] (India)
RCT		Simvastatin
1.2% SIM gel		38
Chronic periodontitis
Well-controlled type II diabetes
Nonsmokers		Nonsurgical treatment
Group I:
Group II:
9 months follow-up		↘ PD
↗ mean CAL gain
↗ mean radiographic bone fill
↘ mSBI		Simvastatin increased periodontal regeneration and CAL gain
[152] (India)
RCT		Rosuvastatin
1.2% rosuvastatin (RSV) gel		65
Chronic periodontitis
Healthy (nonsmokers)		Nonsurgical treatment
Group I:
Group II:
6 months follow-up		↘ mSBI
↘ PD
↗ mean CAL gain
↗ IBD fill		Rosuvastatin increased periodontal regeneration and CAL gain
[20] (India)
RCT		Atorvastatin + rosuvastatin
1.2% RSV and 1.2% ATV gel		90
Chronic periodontitis
Healthy (nonsmokers)		Nonsurgical treatment
Group I:
Group II: RSV gel
Group III: ATV gel
9 months follow-up		The 2 statins lead to the following:
↘ mSBI
↘ PD
↗ mean CAL gain
↗ IBD fill
Statistically greater results for RSV than for ATV for PD reduction, CAL gain, IBD reduction, and msSBI reduction		Atorvastatin and rosuvastatin increased periodontal regeneration and CAL gain
[106] (India)
RCT		Rosuvastatin
1.2% RSV gel		90
Chronic periodontitis
Healthy (nonsmokers)		Surgical treatment
2/3-walled intrabony defects
Group I: OFD alone
Group II:
Group III: RSV gel
9 months follow-up		↘ PD
↗ mean CAL gain
↗ IBD fill		Rosuvastatin increased periodontal regeneration and CAL gain
[107] (India)
RCT		Rosuvastatin
1.2% RSV gel		110
Chronic periodontitis
Healthy (nonsmokers)
Mandibular degree II furcation defects		Surgical treatment
Group 1: gel
Group II:
Group III:
9 months follow-up		↘ PD
↗ mean CAL gain
↗ IBD fill
↘ PI and mSBI		Rosuvastatin increased periodontal regeneration and CAL gain
[153] (India)
RCT		Atorvastatin
1.2% atorvastatin gel		90
Chronic periodontitis
Healthy patients (nonsmokers)
Intrabony defect		Nonsurgical treatment
Group I:
Group II: ATV
Group III: group
9 months follow-up		↘ PD
↗ mean CAL gain
↗ IBD fill
↘ mSBI		Local delivery of atorvastatin increased periodontal regeneration
[154] (India)
RCT		Simvastatin
0.1 mL SIM gel (1.2 mg/0.1 mL)		24
Aggressive periodontitis
Healthy patients (nonsmokers)
Intrabony defect		Nonsurgical treatment
Group I: gel
Group II: gel
6 months follow-up		↘ PD
↗ mean CAL gain
↗ IBD fill
↘ mSBI
All patients tolerated the drug with no postapplication complications
No statistically significant difference between groups I and II regarding PI		Simvastatin increased periodontal regeneration
[108] (India)
RCT		Simvastatin
1.2 mg Simvastatin gel		20
Chronic periodontitis
Healthy patients (nonsmokers)		Surgical treatment
in the mandibular molar region bilaterally
Group I:
Group II: gel
9 months follow-up		↗ IBD fill for group I
Significant results at 9 months in both groups:
↘ GI, PD
↗ mean CAL gain		Simvastatin increased periodontal regeneration
[155] (India)
RCT		Simvastatin
10 μL prepared SIM gel (1.2 mg/0.1 mL)		40
Chronic periodontitis
Healthy patients
Smokers only		Nonsurgical treatment
Group I: SRP + SIM 1.2%
Group II:
9 months follow-up		↘ mSBI
↘ PD
↗ mean CAL gain
↗ IBD fill		Simvastatin increased periodontal regeneration and CAL gain
[156] (India)
RCT		Simvastatin
1.2% simvastatin gel		60
Chronic periodontitis
Healthy (nonsmokers)		Nonsurgical treatment
Group A:
Group B: gel
6 months follow-up		↘ mSBI and PD
↗ mean CAL gain
↗ IBD fill
↘ IL-6 levels		This study showed the efficacy of SIM as a local drug delivery system in the treatment of chronic periodontitis not only in clinical but also in molecular levels
[137] (Chile)
RCT		Atorvastatin
2% atorvastatin dentifrice		36
Chronic periodontitis
Controlled diabetic only
All types of smoking status		Nonsurgical treatment
Group I: dentifrice
Group II: dentifrice
1 month follow-up		↘ PISA
↘ mean PD
↘ % of sites with
↗ mean CAL gain
↘ % of sites with
↘ BOP
↘ GI		Simvastatin increased periodontal regeneration and CAL gain
[100] (India)
Cohort study		Atorvastatin + simvastatin
Drug in sodium alginate suspension administered with calcium chloride solution, subgingival delivery
1.2% simvastatin, or 1.2% atorvastatin		45
Moderate to severe chronic periodontitis
Healthy (nonsmokers)		Nonsurgical treatment
Group I: SRP alone
Group II: SIM
Group III: ATV
6 months follow-up		The test groups did not show any statistically significant difference when compared with the control groupNo significant benefit for periodontal regeneration with the use of statin