Maxillary sinus lift using osteoinductive simvastatin combined with β-TCP versus β-TCP - a comparative pilot study to evaluate simvastatin enhanced and accelerated bone formation

Alveolar ridge splitting and simvastatin loaded xenograft for guided bone regeneration and simultaneous implant placement: randomized controlled clinical trial

OBJECTIVES

The present study goal was to assess clinically and radiographically using simvastatin (SMV) loaded xenograft for guided bone regeneration (GBR) around simultaneously placed implants with alveolar ridge splitting in patients with horizontally atrophic jaw defect.

MATERIALS AND METHODS

Randomized distribution of the twenty-two patients into two groups (11 patients each) was performed. Group I participants received alveolar ride splitting (ARS) with GBR using SMV gel mixed bone graft and a barrier membrane with simultaneous implant placement. Group II received the same treatment protocol without SMV gel. At the baseline, 6- and 9-months post-surgery, clinical and radiological alterations were assessed.

RESULTS

Six months after therapy, PES records of group I were statistically significantly improved than those of group II (P < .001). Group I exhibited statistically significant expansion of the alveolar ridge over group II after 6 and 9 months (P < .001). When compared to group II over the evaluation interval between 6 and 9 months, group I demonstrated statistically substantially minimal loss of the mean marginal bone level (P < .001). At the 6- and 9-month observation periods, bone density gain was considerably higher in group I than that in group II (P < .001).

CONCLUSION

Alveolar ridge splitting along with GBR-augmented SMV improve the clinical and radiographical outcomes around dental implant over GBR alone.

CLINICAL RELEVANCE

Augmenting GBR with SMV in alveolar ridge splitting could boost implant osseointegration and enhance peri-implant tissue changes.

CLINICAL TRIAL REGISTRATION

NCT05020405.

Exploring the Synergistic Effect of Simvastatin in Oral Health Applications: A Literature Review

Statins are the first line of treatment for hyperlipidaemia. Along with lowering lipids, it also lowers mortality and cardiovascular risk. Statins play a major role in maintaining the homeostasis of the oral cavity via a number of different mechanisms. It includes regeneration of dentin and pulp by differentiation and increased development of mineralized tissue via the bone morphogenetic proteins (BMP)-2 Pathway. It shows effective bone health by leading to osteogenic differentiation mesenchymal stem cells, by facilitating epithelization process in wound healing, anti-inflammatory, antioxidant, antimicrobial, antiviral, and fungicidal properties. To the finest of the information we have, there have been very few comprehensive studies that have investigated the effects of statin drugs on various aspects of dental and oral health. As a result, the main objective of this review was to examine the effect of statins on oral health applications. According to the findings of our extensive review, statins have noteworthy and promising effects on several aspects of oral health, including dental pulp cells, chronic periodontitis, alveolar bone loss, orthodontic tooth movement, and so on. Nevertheless, it is concluded that local or even systemic administration of simvastatin should be regarded as an innovative, easily accessible, and safe therapeutic agent that has a significant impact on enhancing the oral health.

Effect of local application of platelet-rich fibrin scaffold loaded with simvastatin on peri-implant bone changes

Aim

The purpose of this study was to compare the effects of autologous platelet-rich fibrin (PRF) alone and PRF loaded with SIM on peri-implant bone changes and implant stability in patients undergoing implant rehabilitation.

Settings and Design

This was a nonrandomized controlled split-mouth study.

Materials and Methods

The study included 8 males between the ages of 45 and 60 years. Each patient received two implants, one on each side of the arch. One side was treated with PRF alone and the other side with PRF loaded with SIM at the time of osteotomy. A cone-beam computed tomography was used to evaluate bone changes around the insertion of implant sites at 3, 6, and 12 months postoperatively. The secondary outcome included measuring implant stability using Osstell device at baseline and 3 months postinsertion. To compare groups at different time periods, data were examined using a two-way analysis of variance.

Statistical Analysis Used

The results were compared between the groups using a two-way analysis of variance, followed by a post hoc Bonferroni test. To examine total bone changes and stability comparisons between the two groups at the end of the trial, an unpaired t-test was utilized.

Results

The mean crestal bone-level changes in the SIM/PRF group were significantly lower than the PRF group, with a mean shift of 0.9788 ± 0.04853 versus 1.356 ± 0.0434, respectively (P < 0.0001). There was no significant difference between the two groups in implant stability.

Conclusion

Peri-implant application of SIM/PRF resulted in less bone changes than PRF alone, which may prove to be beneficial for the long-term success of implants. SIM showed promising results in limiting peri-implant bone resorption providing new clinical application for SIM in dental implant rehabilitation.

Simvastatin-Incorporated Drug Delivery Systems for Bone Regeneration

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.

The Application of Statins in the Regeneration of Bone Defects. Systematic Review and Meta-Analysis

This systematic review aims to analyze the effect of the local application of statins in the regeneration of non-periodontal bone defects. A systematic study was conducted with the Pubmed/Medline, Embase, Cochrane Library and Scielo databases for in vivo animal studies published up to and including February 2019. Fifteen articles were included in the analysis. The local application of the drug increased the percentage of new bone formation, bone density, bone healing, bone morphogenetic protein 2, vascular endothelial growth factor, progenitor endothelial cells and osteocalcin. Meta-analyses showed a statistically significant increase in the percentage of new bone formation when animals were treated with local statins, in contrast to the no introduction of filling material or the introduction of polylactic acid, both in an early (4–6 weeks) and in a late period (12 weeks) (mean difference 39.5%, 95% confidence interval: 22.2–56.9, p <0.001; and mean difference 43.3%, 95% confidence interval: 33.6–52.9, p < 0.001, respectively). Basing on the animal model, the local application of statins promotes the healing of critical bone size defects due to its apparent osteogenic and angiogenic effects. However, given the few studies and their heterogenicity, the results should be taken cautiously, and further pilot studies are necessary, with radiological and histological evaluations to translate these results to humans and establish statins’ effect.

The impact of simvastatin intervention on the healing of bone, soft tissue, and TMJ cartilage in dentistry: a systematic review and meta-analysis

The review aimed at assessing the osteopromotive potential as well as soft tissue and temporomandibular joint (TMJ) cartilage healing properties of simvastatin by summarizing its efficacy on the current dental treatment of periodontal bone and soft tissue defects, and temporomandibular joint (TMJ) arthritis from the available animals and human studies. An electronic search was performed on MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) using a combination of keywords. A hand search was undertaken on seven oral surgery journals. No limitation of publication year in the English language was placed. Controlled randomized animal and human clinical trials, as well as prospective comparative studies, were included. Data on the comparison of topical/systemic simvastatin on bone healing in intrabony and furcation defects, extraction sockets, distraction osteogenesis, as well as soft tissue healing in mucogingival grafting procedures and cartilage protection in TMJ arthritis were extracted from all the eligible studies. Studies with a minimum of ten participants and follow up at least 6 months were included. Ten animal studies and six clinical studies were included in this study. All the animal studies included a minimum of eight sites per group assessed clinically, histologically, and radiographically. All human studies included clinical and radiological evaluation. The results of the review show that simvastatin administration displays positive treatment outcomes in the full range of therapies investigated in the oral regions such as periodontal infection control, periodontal and alveolar bone regeneration, soft tissue grafting, TMJ inflammation reduction, and cartilage repair. Its mechanism includes stimulating bone formation, promoting soft tissue healing, increasing articular and condylar cartilage thickness, as well as reducing inflammation at surgical sites in TMJ disorders. Simvastatin administration is beneficial to the healing of oral bone and cartilage. More studies are desired to determine its potential in soft tissue healing.

Melatonin decorated 3D-printed beta-tricalcium phosphate scaffolds promoting bone regeneration in a rat calvarial defect model

3D-printed β-TCP scaffolds decorated with melatonin via dopamine mussel-inspired chemistry enhance the osteogenesis and in vivo bone regeneration.