Title	Adjunctive Statin Therapy Improves Clinical Parameters in Initial Phase Treatment of Chronic Periodontitis
Clinical Question	Is adjunctive use of statins with scaling and root planing more effective than scaling and root planing alone in the treatment of chronic periodontitis?
Clinical Bottom Line	Statin therapy (systemic or local delivery) may positively enhance the effect of non-surgical initial phase scaling and root planing therapy in the treatment of chronic periodontitis.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22420871 Pradeep/2009 Chronic Periodontitis (n=60) Randomized Controlled Trial Key results The simvastatin treatment group resulted in a statistically significant changes in the following periodontal parameters compared to the control: Decreased mSBI (mean sulcular bleeding index) - 2.3267 +/- 0.8017 vs. 0.5033 +/- 0.6815 Decreased probing depth - 4.26 +/- 1.59 vs. 1.20 +/-1.24mm Decreased IBD (intrabony defects) - 32.54% vs. 2.16% Increased CAL - 4.36 +/- 1.92 vs. 1.63 +/- 1.99mm Both groups had significantly improved probing depths and CAL from initial to final. 20825523 Fajardo/2010 Chronic Periodontitis (n=38) Randomized Controlled Trial Key results Systemic atorvastatin resulted in a statistically significant decrease in tooth mobility (-0.17 +/- 0.11 vs. -0.06 +/- 0.11%, p<0.04) and increase in alveolar bone height (-0.75 +/- 0.7 vs. 0.09 +/- 0.4mm, p<.0006) compared to the control group. Both groups showed improved probing depths, but this was not significant between groups.
Evidence Search	statin therapy AND treatment AND chronic periodontitis
Comments on The Evidence	Two randomized controlled trials have assessed the adjunctive use of statin therapy with scaling and root planing in the treatment of chronic periodontitis. Each utilized a different delivery method and type of statin agent, but both articles suggest improved periodontal parameters with statin therapy versus traditional scaling and root planing alone. Further research is needed to verify the validity of this type of therapy and compare the drug types and delivery methods, as well.
Applicability	Applicable to patients with chronic periodontitis
Specialty	(Periodontics) (Dental Hygiene)
Keywords	statin therapy, chronic periodontitis
ID#	2306
Date of submission	08/02/2012
E-mail	eaves@uthscsa.edu
Author	Kayleigh Eaves
Co-author(s)
Co-author(s) e-mail
Faculty mentor	David Lasho, DDS, MSD
Faculty mentor e-mail	lasho@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) by Kayleigh Eaves (San Antonio, TX) on 09/17/2012 The effects of statins on bone and therefore its positive effects in treatment of chronic periodontitis can be summarized as follows: 1. Increased alkaline phosphatase, BMP-2, and therefore bone mineralization and differentiation of osteoblasts. 2. Increased bone sialoprotein, osteocalcin, and collagen type 1 coupled with decreased matrix metalloproteinases to promote osteoblast differentiation. 3. Increased VEGF expression to enhance osteoblast function. 4. Increased PDGF to promote osteoblast migration. All of these effects may contribute to the positive effects achieved when using statins as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis. PMID 1647028.
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available