Chronic periodontitis is very common. Non-surgical scaling and root planing (SRP) is the main treatment approach. A range of adjunctive agents including doxycycline, minocycline and chlorhexidine have been tested in local delivery to improve its effectiveness. More recently statins including simvastatin, atorvastatin and rosuvastatin have been tested.

The aim of this review was to evaluate if adjunctive local delivery of statins is more effective than SRP alone for patients with chronic periodontitis.

Methods

Searches were conducted in the Cochrane Library and Medline. Randomised controlled trials (RCTs) evaluating local delivery of statins as adjuncts to nonsurgical periodontal treatment and published in English were considered. Three reviewers independently selected studies. Data was abstracted and study quality assessed using the Cochrane risk of bias tool. Random effects meta-analyses were conducted for pocket depth change and clinical attachment gain.

Results

• 10 RCTs involving a total of 641 patients (582 completed follow up) were included.
• All the studies were conducted in India.
• 7 studies were considered to have an unclear risk of bias and 3 a high risk.
• 6 RCTS included only non-smoker systemic healthy individuals, 2 included systemically health smoker and 2 trials included patients with type II diabetes. 6 RCTs tested local atorvastatin, 3 simvastatin gel, 2 rosuvastatin gel.
• All studies reported significant improvements in pocket depth (PD) and clinical attachment levels(CAL)
• Pooled calculations showed that local delivery of statins resulted in additional reduction of
  • PD (Weighted mean difference (WMD) =2.42 mm (95%CI; 2.17-2.66) P=.0009, I2=68%) and
  • CAL; WMD= 2.44 mm (95%CI; 2.15-2.73; P<.00001, I2=77%.
• Subgroup analysis found that the benefits were independent of the systemic condition or type of local statin used.

Conclusions

The authors concluded: –

Local statins may offer additional benefits to nonsurgical periodontal treatment, irrespective of health or smoking status.

Comments

Just two key databases were searched for this review and only English language publication were considered so it is possible that some relevant studies could have been missed.  All the included studies were from the same country, India which is worth bearing in mind when considering the generalisability of the findings.  In addition to this all the studies were of relatively short duration with the majority ( 7studies) having 9 months follow up, with the other 3 being of just 6-months duration. All except 1 of the studies reported that that they receive support from pharmaceutical companies and many are from the same research group.

As with an earlier review by Sinjab et al  positive effects on PD and CAL were seen with statin use. However, there was considerable heterogeneity between the studies and several studies only tested one site per patient.   While the and the earlier review suggest a benefit form the adjunctive use of statins with SRP from the treatment of chronic periodontitis the current findings should be interpreted with caution. Further well conducted and reported RCTs with at least 12 months follow up are needed from different countries and research groups to further clarify these findings.

Links

Primary paper

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. 2017 Sep 5. doi: 10.1111/jre.12480. [Epub ahead of print] Review. PubMed PMID: 28872188.

Original review protocol on PROSPERO

Other references

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;88:357-367