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Diniz JA, Dourado ACAG, Barbirato DDS, da Silveira KG, Vasconcellos RJDH, Laureano Filho JR. Effect of simvastatin topical use on alveolar bone after tooth extraction: a scoping review. Clin Oral Investig 2024; 28:86. [PMID: 38195898 DOI: 10.1007/s00784-023-05482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Conducting a scoping review (SR) to assess scientific evidence for topical simvastatin's impact on alveolar bone regeneration and determine its level of support for clinical applications. MATERIALS AND METHODS This SR followed the PRISMA-ScR and OSF registries protocol; systematic searching was conducted on MEDLINE/PubMed, Cochrane, Embase, Scopus, Web of Science, and LILACS, to identify relevant articles until June 2023. Inclusion criteria covered clinical trials, case series, prospective and retrospective studies, along with in vivo investigations, involving participants of any sex and age. RESULTS Out of 1312 identified studies, 20 (9 in vivo, 11 RCTs) met inclusion criteria. RCTs focused on third molar extraction, in vivo on mandibular incisor surgery. The majority of RCTs employed a collagen sponge and a simvastatin concentration of 10mg; conversely, most in vivo studies favored polylactide-co-glycolide and a 2 mg simvastatin concentration. RCTs had 3-month follow-ups; in vivo, studies extended to 8 weeks. Seven RCTs assessed pain outcomes, simvastatin did not significantly affect pain in six studies. Among four RCTs on postoperative swelling, only two observed a significant increase in the simvastatin group. In general, positive bone formation and the absence of adverse effects directly linked to topical simvastatin were observed across the study models. CONCLUSIONS Intra-alveolar simvastatin post-tooth extraction has been to be shown to be effective and safe for preserving alveolar bone, with varied concentrations and carriers, with no significant adverse effects. CLINICAL RELEVANCE This review provides critical insights into the effects of simvastatin on alveolar bone regeneration, informing potential benefits and possible challenges associated with its post-extraction application. OSF REGISTRY PROTOCOL: osf.io/q3bnf.
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Affiliation(s)
- Jiordanne Araújo Diniz
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco, Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil
| | - Ana Cláudia Amorim Gomes Dourado
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco, Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil.
| | - Davi da Silva Barbirato
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco, Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil
| | - Karoline Gomes da Silveira
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco, Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil
| | | | - José Rodrigues Laureano Filho
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco, Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil
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Deepanjali M, Prasad TS, Manodh P. Efficacy of simvastatin in bone regeneration after surgical removal of mandibular third molars. Oral Maxillofac Surg 2023; 27:427-432. [PMID: 35648294 DOI: 10.1007/s10006-022-01081-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the efficacy of simvastatin in bone regeneration in extraction sockets of mandibular third molars using cone beam computed tomography (CBCT) at 6th post-operative month. METHODS This is a prospective randomized split-mouth study involving 15 patients who underwent surgical extraction of bilaterally impacted mandibular third molars with similar morphology on the same day. The efficacy of drug was analyzed by implanting 10 mg of simvastatin into the socket (study site) and observations were made over 6 months to compare the healing with the control site. RESULTS The study results demonstrated a statistically significant difference in bone regeneration: mean gray value of 429.133 in study site compared with mean gray value of 310.153 in the control site. CONCLUSION These values demonstrate significant change in bone regeneration in simvastatin site as compared to that of control site.
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Affiliation(s)
| | | | - Pedamally Manodh
- Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
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Harsha G, Madhavi S, Arthi S, Haritha S. Evaluation of efficacy of simvastatin in bone regeneration following local application in third molar extraction socket: A randomized control trial. Natl J Maxillofac Surg 2023; 14:286-293. [PMID: 37661989 PMCID: PMC10474535 DOI: 10.4103/njms.njms_317_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/27/2021] [Accepted: 09/30/2021] [Indexed: 09/05/2023] Open
Abstract
Aims and Objectives The aim of this study is to study the efficacy of simvastatin in bone regeneration following the local application in third molar extraction sockets. Materials and Methods This is a randomized controlled trial done on 50 patients involving 100 third molar teeth extraction sockets. The patients were randomly divided based on the placement of simvastatin. Extraction sockets which were treated with simvastatin were considered study sockets and without simvastatin were considered control sockets. The study socket was assigned for the placement of simvastatin (10 mg) powder along with gelfoam as carrier moistened with normal saline solution and control socket was assigned for the placement of gelfoam moistened with saline. Intraoral periapical radiographs were taken on the 1st, 4th, 8th, and 12th weeks, and mean gray scale values indicating bone density were evaluated for both the groups. Cone-beam computed tomography (CBCT) was taken by the end of the 12th week to further evaluate the osseous regeneration. Patients were compared and evaluated for bone density, pain, and swelling. Pain and swelling were evaluated on postoperative days 1 and 7. Results The mean gray-level histogram values (bone density) were statistically highly significant in the study group compared to the control group in the 1st, 4th, 8th, and 12th weeks, and CBCT also showed statistically significant difference between the control and study group by the end of the 12th week. Conclusion The present data suggest that the local application of simvastatin promotes and enhances bone formation in the extraction sockets, which provides a very cost-effective way for faster bone regeneration.
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Affiliation(s)
- Gorrela Harsha
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Hyderabad, Telangana, India
| | - Sunnam Madhavi
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Hyderabad, Telangana, India
| | - Sirivore Arthi
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Hyderabad, Telangana, India
| | - Siripuram Haritha
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Hyderabad, Telangana, India
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Tomographic evaluation of the effect of simvastatin topical use on alveolar bone microarchitecture, pain and swelling after mandibular third molar extraction: a randomized controlled trial. Clin Oral Investig 2022; 26:3533-3545. [DOI: 10.1007/s00784-021-04322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
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Jin H, Ji Y, Cui Y, Xu L, Liu H, Wang J. Simvastatin-Incorporated Drug Delivery Systems for Bone Regeneration. ACS Biomater Sci Eng 2021; 7:2177-2191. [PMID: 33877804 DOI: 10.1021/acsbiomaterials.1c00462] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Local drug delivery systems composed of biomaterials and osteogenic substances provide promising strategies for the reconstruction of large bone defects. In recent years, simvastatin has been studied extensively for its pleiotropic effects other than lowering of cholesterol, including its ability to induce osteogenesis and angiogenesis. Accordingly, several studies of simvastatin incorporated drug delivery systems have been performed to demonstrate the feasibility of such systems in enhancing bone regeneration. Therefore, this review explores the molecular mechanisms by which simvastatin affects bone metabolism and angiogenesis. The simvastatin concentrations that promote osteogenic differentiation are analyzed. Furthermore, we summarize and discuss a variety of simvastatin-loaded drug delivery systems that use different loading methods and materials. Finally, current shortcomings of and future development directions for simvastatin-loaded drug delivery systems are summarized. This review provides various advanced design strategies for simvastatin-incorporated drug delivery systems that can enhance bone regeneration.
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Affiliation(s)
- Hui Jin
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, P.R. China.,Department of Pain, The Second Hospital of Jilin University, Changchun 130041, P.R. China
| | - Youbo Ji
- Department of Pain, The Second Hospital of Jilin University, Changchun 130041, P.R. China
| | - Yutao Cui
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, P.R. China
| | - Li Xu
- Department of Orthopedics, Weihai Guanghua Hospital, Weihai 264200, P.R. China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, P.R. China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, P.R. China
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Ying Y, Li B, Liu C, Xiong Z, Bai W, Li J, Ma P. A biodegradable gelatin-based nanostructured sponge with space maintenance to enhance long-term osteogenesis in maxillary sinus augmentation. J Biomater Appl 2020; 35:681-695. [PMID: 33059516 DOI: 10.1177/0885328220964446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The search for bone substitutes that are biodegradable, ensure space maintenance, and have osteogenic predictability, is ongoing in the field of sinus augmentation. We thus compared the bone regeneration potential of nanostructured sponges (NS-Sponge) with that of collagen-stabilized inorganic bovine bones (BO-Collagen), gelatin sponges (Gelatin), and blood clots (Cont) in sinus augmentation of rabbits. NS-Sponge was prepared by thermally induced phase separation with porogen leaching techniques. All the materials were non-hemolytic and cytocompatible. The porous and nanofibrous NS-Sponge showed better dimensional stability to support cell growth and osteogenic differentiation. In vivo, the sinus membrane collapsed in Cont and Gelatin, while BO-Collagen and NS-Sponge maintained the elevated height as assessed by come-beam computed tomography. Limited bone regeneration was observed in Cont and Gelatin. In the entire implanted area, histological analysis revealed a higher percentage of new bone area at 4 weeks of BO-Collagen treatment; however, a significantly greater increase in new bone area was observed after 12 weeks of NS-Sponge treatment. The 12-week remnant NS-Sponge material was significantly lower than the 4-week remnant material. Overall, NS-Sponge may be highly recommended for sinus augmentation, as it exhibits numerous advantages, including excellent operability, clear imaging characteristics, space maintenance, biodegradability, and superior osteogenic potential.
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Affiliation(s)
- Yiqian Ying
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Beibei Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Changying Liu
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Zuochun Xiong
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
| | - Wei Bai
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
| | - Jun Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - Pan Ma
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
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Gupta S, Verma P, Tikku AP, Chandra A, Yadav RK, Bharti R, Bains R. “Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study. J Oral Biol Craniofac Res 2020; 10:583-591. [DOI: 10.1016/j.jobcr.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022] Open
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Degala S, Bathija NA. Evaluation of the Efficacy of Simvastatin in Bone Regeneration after Surgical Removal of Bilaterally Impacted Third Molars-A Split-Mouth Randomized Clinical Trial. J Oral Maxillofac Surg 2018; 76:1847-1858. [PMID: 29859160 DOI: 10.1016/j.joms.2018.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Simvastatin has been reported to promote osteoblastic activity, inhibit osteoclastic activity, and support osteoblast differentiation induced by bone morphogenetic protein. This split-mouth randomized clinical trial evaluated the effect of local application of simvastatin (10 mg) on bone regeneration after surgical removal of bilaterally impacted mandibular third molars. MATERIALS AND METHODS A randomized, split-mouth, single-blinded, single-center trial was performed in 30 patients 18 to 40 years old requiring surgical extraction of bilaterally impacted mandibular third molars. These patients underwent 2 surgical sessions, with extraction of 1 third molar during each session. Each participant was randomly assigned to receive Gelfoam soaked with normal saline or with the drug simvastatin (10 mg) at the first session and were blinded to the use of drug for that particular socket. The alternate regimen was used during the second session. The study was conducted over a period of 3 months. Patients were evaluated for pain, postoperative swelling, and bone density measurement and analysis using intraoral periapical radiographs at the end of 1, 4, 8 and 12 weeks, respectively. In addition, cone-beam computed tomographic (CBCT) images were obtained for every fifth patient at the end of 12 weeks. RESULTS Mean gray-level histographic values were significantly higher for the study sockets at the end of 1, 4, 8, and 12 weeks (P = .001) compared with the control sockets (30 sockets each). CBCT analysis further substantiated accelerated bone regeneration in the study sockets. CONCLUSION The study was statistically and radiographically in favor of the drug, indicating that local application of simvastatin could be a cost-effective and simple way to stimulate and hasten osseous regeneration.
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Affiliation(s)
- Saikrishna Degala
- Professor and Head of Department, Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital (Constituent College), Jagadguru Sri Shivarathreeshwara University, Mysuru, Karnataka, India.
| | - Nikita A Bathija
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital (Constituent College), Jagadguru Sri Shivarathreeshwara University, Mysuru, Karnataka, India
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