Chronic periodontitis (CP) is common and is characterized by progressive loss of attachment and destruction of alveolar bone as a result of inflammatory processes, that may lead to tooth loss if not treated. Statins have a range of effects including anti-inflammatory and immunomodulatory effects that have resulted in them being tested as an adjunct to scaling and root planing in the management of CP.
The aim of this review was to assess the efficacy of statins as an adjunct to scaling and root planing (SRP).
Methods
Searches were conducted in the Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases supplemented by hand searches of the journals; Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research.
Randomised controlled trials (RCTs) comparing SRP alone versus SRP with adjunctive statins involving a minimum of 10 patients per group were considered. Two reviewers independently selected studies, abstracted data and assessed risk of bias using the Cochrane tool. The primary outcome was probing depth (PD) with clinical attachment level (CAL) and bone defect (BD) fill as secondary outcomes. These were reported as weighted mean differences (WMD) and separate meta-analyses were carried out for each outcome.
Results
- 11 RCTs were included
- 6 studies used atorvastatin (5 used topical application, 1 oral)
- 4 studies used local simvastatin
- 3 studies used local rosuvastatin
- All 11 studies were considered to be at low risk of bias.
- In all of the included studies, periodontal inflammatory parameters (PD, CAL, and BD fill) showed significantly higher improvements in the statin groups.
| PD reduction
WMD(95%CI) |
CAL gain
WMD(95%CI) |
BD fill
WMD(95%CI) |
|
| Atorvastatin | −1.84, (−2.56 to −1.12) | −2.31, (−3.58 to −1.03) | −2.66, (−3.92 to −1.39) |
| Simvastatin | −1.91, (−2.27 to −1.55) | −1.91, (−2.27 to −1.55) | −1.52, (−2.20 to −0.85) |
| Rosuvastatin | −0.94, ( −1.32 to −0.55) | −1.00, (−1.41 to −0.60) | −1.30, (−1.80 to −0.79) |
Conclusions
The authors concluded: –
Adjunctive statin delivery appears to be effective in reducing PD, CAL gain, and BD fill in CP, and thus, these drugs could be a promising therapeutic option for periodontal regeneration in future
Comments
Last month we looked at another review by Ambrósio et al of this topic (Dental Elf- 1st Nov 2017). This new review has undertaken a broader database search and included 11 RCTs compared with 10 in the previous review. Essentially the same trials are included in both reviews although the Ambrósio review does rate the quality of the included studies at more risk of bias than this new review. As noted previously the studies have been conducted in a single country and are of relatively short duration. A majority of the studies use local delivery of statins and statistically significant benefits were found for all the outcomes reported. While the results are promising further larger and well-conducted studies of longer duration in a range of settings are needed to confirm these findings.
Links
Primary Paper
Akram Z, Vohra F, Javed F. Efficacy of statin delivery as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A meta-analysis. J Investig Clin Dent. 2017 Nov 9. doi: 10.1111/jicd.12304. [Epub ahead of print] Review. PubMed PMID: 29119729.
Other references
Original review protocol in PROSPERO
Dental Elf- 1st Nov 2017
Scaling and root planing: Do adjunctive statins improve effectiveness?
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