Clinical efficacy of subgingivally delivered simvastatin gel in chronic periodontitis patients

Agarwal, Swati; Chaubey, Krishna Kumar; Chaubey, Abhinav; Agarwal, Vikas; Madan, Ellora; Agarwal, Manvi Chandra

doi:10.4103/0972-124x.194270

Cited by 19 publications

(17 citation statements)

References 33 publications

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“…Notably, 17 out of 32 clinical studies were carried out by the same group of researchers on similar population; therefore, generalizations should be drawn with caution. Additionally, in most studies involving statins, the follow-up period was no longer than 9 months [ 103 , 130 ]. Hence, it is imperative to follow clinical studies for periods longer than those commonly investigated so as to achieve a deeper and more genuine insight into their long-term benefits.…”

Section: Discussionmentioning

confidence: 99%

Contribution of Statins towards Periodontal Treatment: A Review

Petit

Batool

Bugueno

et al. 2019

Mediators of Inflammation

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The pleiotropic effects of statins have been evaluated to assess their potential benefit in the treatment of various inflammatory and immune-mediated diseases including periodontitis. Herein, the adjunctive use of statins in periodontal therapy in vitro, in vivo, and in clinical trials was reviewed. Statins act through several pathways to modulate inflammation, immune response, bone metabolism, and bacterial clearance. They control periodontal inflammation through inhibition of proinflammatory cytokines and promotion of anti-inflammatory and/or proresolution molecule release, mainly, through the ERK, MAPK, PI3-Akt, and NF-κB pathways. Moreover, they are able to modulate the host response activated by bacterial challenge, to prevent inflammation-mediated bone resorption and to promote bone formation. Furthermore, they reduce bacterial growth, disrupt bacterial membrane stability, and increase bacterial clearance, thus averting the exacerbation of infection. Local statin delivery as adjunct to both nonsurgical and surgical periodontal therapies results in better periodontal treatment outcomes compared to systemic delivery. Moreover, combination of statin therapy with other regenerative agents improves periodontal healing response. Therefore, statins could be proposed as a potential adjuvant to periodontal therapy. However, optimization of the combination of their dose, type, and carrier could be instrumental in achieving the best treatment response.

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Section: Discussionmentioning

confidence: 99%

Contribution of Statins towards Periodontal Treatment: A Review

Petit

Batool

Bugueno

et al. 2019

Mediators of Inflammation

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“…19 The local delivery of simvastatin in grade II furcation defects and in periodontal pockets enhances the outcome of mechanical therapy resulting in reduced pocket depths, improved attached gain and bone fill. 20,21 Alkaline phosphatase has been measured in GCF to examine the relationship between periodontal conditions and disease activity. Increased alkaline phosphatase activity in relation to inflammation is observed in gingivitis and periodontitis.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Gingival Crevicular Fluid Alkaline Phosphatase in Postmenopausal Women Treated With Subgingival Simvastatin

S¹,

Patel²,

Gujjari³

et al. 2018

jemds

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BACKGROUND Women at menopause are found to be at risk for decreased bone density and chronic periodontitis due to oestrogen deficiency and common risk factors. Statins have anti-inflammatory and anti-resorptive properties and are successfully used in postmenopausal osteopenia. Increased alkaline phosphatase activity is observed in periodontitis. Thus, 1.2 mg Simvastatin gel was used subgingivally in this study. The level of alkaline phosphatase was evaluated in the sites treated as a biomarker. MATERIALS AND METHODS 20 systemically healthy postmenopausal subjects were sampled. Two bilateral pockets (≥ 4 mm) in each subject were randomised. After phase I therapy, the selected sites were randomised as either site A or site B. The sites received either 1.2 mg Simvastatin insitu gel or a placebo gel. An assessment of the probing depth and clinical attachment level was made on the baseline and at 3 months interval. Gingival crevicular fluid was tested for alkaline phosphatase levels on baseline, 14th day and 90th day post-operatively. Statistical analysis included descriptives, repeated measure ANOVA, Wilks' Lamdba, paired and independent sample t-test. RESULTS The test and control sites demonstrated improvements in clinical parameters, which was statistically significant (p < 0.05). Further, the test sites showed statistically significant improvement over the control sites. A significant decrease in GCF alkaline phosphatase levels was observed in both test and control sites after 14 days. However, the test sites showed significantly higher values than control sites. Although not significant, the alkaline phosphatase levels further decreased in test sites when evaluated after 90 days. CONCLUSION The use of simvastatin in-situ gel in periodontal pockets showed satisfactory clinical improvement owing to its prolonged antiinflammatory property. It can be a promising adjunct to conventional protocols employed in management of periodontal disease in postmenopausal subjects.

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“…Subgingivally delivered simvastatin gel in chronic periodontitis could enhance the beneficial effect of scaling and root planing (SRP) in pocket reduction, gain in CAL, and bone loss. [72] The effect of different concentrations of local Rosuvastatin (0.1 and 1 mg) in calvarial bone defects was studied, and it was observed that local administration of 1 mg of Rosuvastatin enhanced bone regeneration in calvarial rat defect. [73] Systematic review and meta-analysis find that adjunctive use of locally delivered statins to mechanical SRP is beneficial to increasing bone fill percentage.…”

Section: Evidence Based Overview Linking Periodontal Infection and Hymentioning

confidence: 99%

Critical appraisal of bidirectional relationship between periodontitis and hyperlipidemia

Abraham¹,

Premnath²,

Arunima³

et al. 2019

J Int Soc Prevent Communit Dent

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Periodontal disease and hyperlipidemia are both multifactorial disease with a high prevalence Worldwide. Cross-sectional and longitudinal prospective clinical studies show some evidence for a bidirectional relationship. Periodontitis and hyperlipidemia share some common risk factors and there exist a mechanistic link between both. Studies have found a positive response to periodontal therapy among hyperlipidemic patients, and statin use by hyperlipidemic patients has shown to influence the periodontal health. However, in spite of the rising prevalence of both diseases, many people remain unaware of their association with each other. Hence, this article summarizes the cyclic relationship between periodontal disease and hyperlipidemia.

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Clinical efficacy of subgingivally delivered simvastatin gel in chronic periodontitis patients

Cited by 19 publications

References 33 publications

Contribution of Statins towards Periodontal Treatment: A Review

Contribution of Statins towards Periodontal Treatment: A Review

Evaluation of Gingival Crevicular Fluid Alkaline Phosphatase in Postmenopausal Women Treated With Subgingival Simvastatin

Critical appraisal of bidirectional relationship between periodontitis and hyperlipidemia

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