08 January 2019

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Efficacy of statins in the treatment of chronic periodontitis

Lara Figini

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INTRODUCTION 

Scaling and root planing (SRP) remains elite treatment in cases of chronic periodontitis. However, these treatments may sometimes not be sufficient, in cases, for example, of deeper pockets and teeth particular positions. This is why adjuvant procedures have been introduced to improve the effectiveness of non-surgical periodontal treatment involving the use of antibiotics, antiseptics and photodynamic therapy. Recently, the use of statins, inhibitors of 3-hydroxy-3-methylglutarylecoenzyme A reductase (HMG-CoA reductase, an important enzyme related to cholesterol synthesis) has also been proposed; these are drugs that prevent mevalone synthesis by reducing prenylation with consequent inhibition of osteoclastic activity, as proteins can not anchor themselves to the osteoclast membrane due to the lack of a lipid chain. A series of human studies has shown that the local application of statins may have additional benefits compared to traditional non-surgical periodontal scaling and root planing treatment alone.

MATERIALS AND METHODS
In a review published in the Clinical Oral Investigation, the effects of treatment of chronic periodontitis (CP) are evaluated with the application of local statins in addition to the classical treatment (SRP), compared to SRP alone or SRP + placebo. The authors performed the electronic and manual literature search using three databases to select relevant randomized controlled trials (RCTs).These trials had to meet the following eligibility criteria:

• randomized controlled trials (RCT) and split-mouth studies on human individuals (≥18 years); 
• studies that have evaluated the local use of statins as adjuvants to the non-surgical treatment of SRP (SRP + statins) and studies that compare SRP + statins with treatments of SRP alone;
• patients who have received non-surgical SRP treatment alone or in multiple placebo (SRP + placebo);
• studies that quantitatively report periodontal parameters, such as clinical attachment level (CAL), periodontal pocket depth (PPD), modified sulcus bleeding index (mSBI) and intraosseous defect depth (IBD), with at least 6 months of follow-up;
• studies that include patients with systemic diseases or risk factors (for example, diabetes or smoking);• studies comparing SRP + statin treatments with SRP alone.

RESULTS
526 articles were identified. Only 15 met the inclusion criteria and were included in the final systematic review and meta-analysis.
The meta-analysis showed a statistically significant CAL gain (p=0,000), a reduction in PPD; a reduction of mSBI and IBD attributable to SRP + statin treatment at the 6-month control (table 1).

Italian version: https://www.odontoiatria33.it/parodontologia/16968/efficacia-delle-statine-nel-trattamento-della-parodontite-cronica.html

CONCLUSIONS
With all the limitations of this review, the evidence that emerges is that the use of locally applied statins as an adjuvant to SRP in the treatment of CP as well as being an easy, low-cost maneuver that guarantees low adverse effects on bacterial resistance appears to be effective in the treatment of chronic periodontitis. These results must be interpreted with caution, requiring further studies to confirm. Clinical implications based on the data emerging from this review, in cases of severe chronic periodontitis refractory to the classic treatment of SRP the dentist may consider the local application of statins in the sites most affected by CP in support of the traditional SRP. The decision should be made considering the clinical values ​​of periodontitis and the patient's preferences.     

For additional information: 
Jonathan Meza-Mauricio, David Soto-Peñaloza, David Peñarrocha-Oltra, Jose Maria Montiel-Company, Daiane Cristina Peruzzo. Locally applied statins as adjuvants to non-surgical periodontal treatment for chronic periodontitis: A systematic review and meta-analysis. Clinical Oral Investigations 2018;22(7):2413-30.