Elsevier

Journal of Dentistry

Volume 67, December 2017, Pages 18-28
Journal of Dentistry

Review article
The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy—A systematic review and meta-analysis

https://doi.org/10.1016/j.jdent.2017.08.011Get rights and content

Abstract

Objectives

To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy.

Data

Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported.

Sources

Medline (PubMed), Embase (Ovid), CENTRAL (Ovid).

Study selection

Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p ≤ 0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group.

Conclusions

Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted.

Section snippets

Background

The use of local and/or systemic adjunct measures [e.g., chlorhexidine, hyaluronan, probiotics, antibiotics (AB), etc.] to mechanical treatment has been a common therapeutic approach aiming for better infection control, reduced tissue destruction by the immune response, and/or enhanced reparative processes. Due to concerns regarding the increasing bacterial resistance, systemic AB do not meet widespread acceptance [1]; thus, non-AB alternatives may be a more reasonable approach.

Statins is an

Protocol and eligibility criteria

The present systematic review was reported according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA; Appendix S1 in Supplementary file) [23], [24]. The following inclusion criteria were applied during literature search on 3 sources (Medline – PubMed; Embase − Ovid; CENTRAL − Ovid; last search 31/12/2016—no date restriction used): (a) English or German language; (b) interventional studies [i.e., controlled or randomized controlled trials (RCT)];

Study selection

The flowchart of the literature search is presented in Fig. 1. Out of 383 identified studies, 26 articles were selected for full-text review; 7 trials [25], [26], [27], [28], [29], [30], [31] were excluded for various reasons (Appendix S3 in Supplementary file). No studies were excluded due to language restriction (i.e. not English or German). Finally, 15 studies on non-surgical [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46] and 4 studies on surgical

Discussion

The rationale to use statins as an adjunct to periodontal treatment has been based on their anti-inflammatory- [6], [7], [8], [9], [10], [11], bone promoting- [12], [13], [14], [15], [16], and anti-MMP- [6], [17], [18] properties. Recently, it was demonstrated that statins also have some anti-microbial properties [19], [20]. Indeed, in several preclinical in vivo trials in rodents, employing standard experimentally-induced periodontitis models, local application or systemic administration of

Source of funding

The authors have not received any particular funding for this article.

Acknowledgements

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

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