Statins in addition to their well-established role in reducing blood cholesterol have other pharmacologic effects for example anti-oxidant and anti-inflammatory properties, angiogenesis, and increased bone formation. Studies also suggest that they may modify periodontal inflammation and positive findings have been shown with their use in periodontal patients.
The aim of this review was to assess the effect of statins in conjunction with mechanical periodontal therapy on probing pocket depth, clinical attachment level, and intrabony defects.
Searches were conducted in the PubMed, Scopus and Embase databases with no restrictions on language or publication date for controlled clinical trials that used any locally delivered or systemically statin as a sole adjunctive therapy to mechanical periodontal treatment for patients with a diagnosis of chronic or aggressive periodontitis. Trials needed to include at least one clinical periodontal measurement, (probing depth, clinical attachment level, and intrabony defect).
Two reviewers independently selected studies. Data was abstracted to a spreadsheet with authors being contacted for missing data. Risk of bias for randomised controlled trials was assessed using the Cochrane tool with the ROBINS-I tool being used for non-randomised studies. Weighted mean differences between baseline and 6 months after periodontal treatment for clinical attachment level (CAL), probing pocket depth (PPD), and intrabony defect (IBD) were calculated
- 15 studies (12 RCTs, 3 non-randomised) involving a total of 736 patients were included.
- The statins used were atorvastatin, simvastatin, and rosuvastatin.
- Only 1 RCT was considered to be at low risk of bias the others were considered high risk.
- 3 studies considered systematic statins with just one finding a significant improvements in PPD and dental mobility.
- I short-term study considered use of a 2% atorvastatin dentifrice compared with a placebo dentifrice suggesting a benefit from use of the 2% atorvastatin dentifrice.
- 11 studies used locally delivered statins. statistically significant reduction in PPD and IDB gain we seen in 10 out of 11 studies and CAL gain in 9 studies.
- For PPD at 6 months, analysis showed a pooled WMD of 1.93 mm (95%CI; 1.44; 2.41), favouring the statin group [10 studies].
- For IDB a pooled WMD of 1.54 mm (95%CI; 1.24; 1.84) was shown, favouring the statin group [9 studies].
- For CAL a pooled WMD of 1.82 mm (95% CI 1.24; 2.41) was found also favouring the statin group [9 studies].
- Overall the GRADE quality of evidence for the outcomes considered to be low.
The authors concluded: –
statins, used as sole adjuncts to mechanical periodontal treatment, additionally improved at least one of the following periodontal parameters: probing pocket depth, clinical attachment level, and intrabony defect. The use of locally delivered statins in periodontal pockets is largely studied. Within the limits of this review, in the meta-regression analyses, simvastatin was the only drug that showed additional benefits in probing depth, clinical attachment level, and intrabony defect, when compared to the groups without statin.
Three well-known databases were searched for this review with no restrictions on language or date. 12 if the 15 included studies were RCTs although none of the studies were large, the biggest involving a total of 81 patients. The longest follow up period was 6 months. Meta-analysis was only conducted for studies using locally delivered statins with simvastatin being the most commonly used (5 studies). It is also worth noting that 9 out of these 11 of studies were from the same research group.
We have previously looked at a review of this topic (Dental Elf – 11th Dec 2017) and that review included 11 studies 8 of which are included in this current review. However, these are not the only two reviews on this topic and a number are listed below. Most of these reviews suggest a beneficial effect from statins, Given the quality of the available evidence assessed in this review as low the focus should now be on larger high quality and well-reported studies of longer duration to provide a clearer picture of the adjunctive effect of statins in managing chronic periodontal disease.
Muniz FWMG, Taminski K, Cavagni J, Celeste RK, Weidlich P, Rösing CK. The effect of statins on periodontal treatment-a systematic review with meta-analyses and meta-regression. Clin Oral Investig. 2018 Mar;22(2):671-687. doi: 10.1007/s00784-018-2354-9. Epub 2018 Feb 2. Review. PubMed PMID: 29396642.
Dental Elf – 11th Dec 2017
Meza-Mauricio J, Soto-Peñaloza D, Peñarrocha-Oltra D, Montiel-Company JM, Peruzzo DC. Locally applied statins as adjuvants to non-surgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis. Clin Oral Investig. 2018 Jun 12. doi: 10.1007/s00784-018-2507-x. [Epub ahead of print] Review. PMID: 29948277 [PubMed – as supplied by publisher]
Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res. 2018 Jun;53(3):267-287. doi: 10.1111/jre.12514. Epub 2017 Dec 6. Review. PMID: 29211309 [PubMed – in process]
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. 2018 May;9(2):e12304. doi: 10.1111/jicd.12304. Epub 2017 Nov 9. Review. PMID: 29119729 [PubMed – in process]
Ambrósio LMB, Rovai ES, Sendyk DI, Holzhausen M, Pannuti CM. Does the adjunctive use of statins provide additional benefits to nonsurgical periodontal treatment? A systematic review and meta-analysis. J Periodontal Res. 2018 Feb;53(1):12-21. doi: 10.1111/jre.12480. Epub 2017 Sep 5. Review. PMID: 28872188 [PubMed – in process]
Bertl K, Parllaku A, Pandis N, Buhlin K, Klinge B, Stavropoulos A. The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis. J Dent. 2017 Dec;67:18-28. doi: 10.1016/j.jdent.2017.08.011. Review. PMID: 28855141 [PubMed – in process]
Sinjab K, Zimmo N, Lin GH, Chung MP, Shaikh L, Wang HL. The Effect of Locally Delivered Statins on Treating Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. J Periodontol. 2017 Apr;88(4):357-367. doi: 10.1902/jop.2016.160384. Epub 2016 Oct 21. PMID: 27767388 [PubMed – in process]
Estanislau IM, Terceiro IR, Lisboa MR, Teles Pde B, Carvalho Rde S, Martins RS, Moreira MM. Pleiotropic effects of statins on the treatment of chronic periodontitis–a systematic review. Br J Clin Pharmacol. 2015 Jun;79(6):877-85. doi: 10.1111/bcp.12564. PMID: 25444240 [PubMed – indexed for MEDLINE]
de Monès E, Schlaubitz S, Catros S, Fricain JC. Statins and alveolar bone resorption: a narrative review of preclinical and clinical studies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Jan;119(1):65-73. doi: 10.1016/j.oooo.2014.09.030. Epub 2014 Oct 5. Review. PMID: 25482549 [PubMed – indexed for MEDLINE]