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

Evaluating Bioassays for the Determination of Simvastatin's Osteogenic Activity: A Systematic Review

OBJECTIVE

Osteogenic differentiation is a complex process, and its analysis requires several biomarkers. Allied with this, there are no standardized bioassays to monitor the activity of simvastatin in osteogenesis in vitro. Therefore, identifying the most efficient and sensitive bioassays may enhance the quality of in vitro studies, bridging the gap with in vivo findings, saving time and resources, and benefiting the community. This systematic review aimed to determine the most efficient bioassay for simvastatin's osteogenic activity in vitro, in terms of sensitivity.

MATERIALS AND METHODS

In vitro studies evaluating undifferentiated mesenchymal cells treated with simvastatin were considered eligible. References were selected in a two-phase process. Electronic databases and the grey literature were screened up to September 2023. The Office of Health Assessment and Translation (OHAT) tool was used to assess the risk of bias. Certainty in cumulative evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Data were analyzed considering extracellular matrix mineralization, alkaline phosphatase, and the expression of potential target genes, such as bone morphogenetic protein-2 (BMP-2), collagen type I, Runt-related transcription factor 2, osterix, osteocalcin, and osteopontin.

RESULTS

Fourteen studies were included. A "probably low" or a "definitely low" risk of bias was assigned to the included studies. The simvastatin concentration ranged from 0.1 nM to 10 µM. Considering a minimum 4-fold increase, simvastatin caused robust mineralization of the extracellular matrix in four studies (4.0-, 4.4-, 5.0-, and 39.5-fold). Moreover, simvastatin substantially increased BMP-2 expression in mesenchymal cells in three studies (4-, 11-, and 19-fold).

CONCLUSION

Therefore, mineralization of the extracellular matrix and BMP-2 expression in mesenchymal cells are the most efficient bioassays for determining the osteogenic activity of simvastatin in vitro (high certainty level). These findings provide a standardized approach that can enhance the reliability and comparability of in vitro studies, bridging the gap with in vivo research and optimizing resources in the field of bone regeneration.

Simvastatin-Loaded Chitosan Microspheres as a Biomaterial for Dentin Tissue Engineering

In the present study, chitosan microspheres (MSCH) loaded with different concentrations of simvastatin (2%, 5%, and 10%) were synthesized as a biomaterial for dentin tissue engineering. The microspheres were prepared by emulsion crosslinking method, and simvastatin was incorporated during the process. The microspheres were then physicochemically and morphologically characterized. Scanning electron microscopy and infrared spectroscopy confirmed the spherical morphology of synthesized microspheres and the chemical incorporation of simvastatin into MSCH, respectively. UV-visible absorption confirmed the controlled and continuous release pattern of the drug. To mimic the clinical application in vitro, the microspheres were applied onto three-dimensional (3D) cultures of human dental pulp cells (HDPCs). Cell viability, proliferation, and in situ-mineralized matrix deposition were evaluated. The results indicated no cytotoxic effects for all 3D cultures for all tested biomaterials, with cells being able to proliferate significantly over time. HDPCs showed a significant increase in the deposition of mineralization nodules when 3D cultures were in direct contact with chitosan microspheres in comparison to control; nevertheless, the highest expression was observed for MSCH encapsulated with 5% and 10% simvastatin, which was significantly higher than plain MSCH. Therefore, chitosan microsphere systems loaded with 5%-10% simvastatin provided the development of a controlled release system in bioactive dosages for dentin tissue engineering.

The pleiotropic effects of statins: a comprehensive exploration of neurovascular unit modulation and blood-brain barrier protection

The blood-brain barrier (BBB) is the most central component of the neurovascular unit (NVU) and is crucial for the maintenance of the internal environment of the central nervous system and the regulation of homeostasis. A multitude of neuroprotective agents have been developed to exert neuroprotective effects and improve the prognosis of patients with ischemic stroke. These agents have been designed to maintain integrity and promote BBB repair. Statins are widely used as pharmacological agents for the treatment and prevention of ischemic stroke, making them a cornerstone in the pharmacological armamentarium for this condition. The primary mechanism of action is the reduction of serum cholesterol through the inhibition of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which results in a decrease in low-density lipoprotein cholesterol (LDL-C) and an increase in cholesterol clearance. Nevertheless, basic and clinical research has indicated that statins may exert additional pleiotropic effects beyond LDL-C reduction. Previous studies on ischemic stroke have demonstrated that statins can enhance neurological function, reduce inflammation, and promote angiogenic and synaptic processes following ischemic stroke. The BBB has been increasingly recognized for its role in the development and progression of ischemic stroke. Statins have also been found to play a potential BBB protective role by affecting members of the NVU. This review aimed to provide a comprehensive theoretical basis for the clinical application of statins by systematically detailing how statins influence the BBB, particularly focusing on the regulation of the function of each member of the NVU.

Simvastatin Efficacy on Endodontic Biofilms: An In Vitro Study

The outcome of endodontic therapy is directly related to the control of infection. The aim of the study was to evaluate in vitro the efficacy of Simvastatin (SIM) and diclofenac (DC) solutions on endodontic biofilms.

METHODS

Mature biofilms were grown on dentin specimens and put in contact with the solutions to determine their antibiofilm activity. To assess residual antimicrobial activity, the dentin samples were immersed for 5 min in the solutions before microbial infection for 3 weeks. The study groups were: (1) 8% SIM, (2) 4% SIM, (3) 4% DC, (4) 2.5% sodium hypochlorite (NaOCl), and (5) 0.9% saline solution (SS). Cell viability was evaluated by means of the adenosine triphosphate (ATP) assay and flow cytometry (FC). The data collected were analyzed with the ANOVA test using Welch's correction followed by the Games-Howell test. The level of statistical significance was p < 0.05, and statistical analysis was performed using SPSS 23.0.

RESULTS

All study groups reduced the biofilms significantly with respect to the control. The highest reduction percentage was obtained by 2.5% NaOCl, followed by SIM 8% and 4%, without statistically significant differences. In terms of residual activity, the 4% DC solution obtained a higher percentage of dead cells.

CONCLUSION

Solutions of 4% and 8% SIM, and 4% Diclofenac, show antimicrobial and residual activity against multispecies endodontic biofilms.

Role of Statins in Oral and Maxillofacial Surgery: A Literature Review

In recent years, there has been a notable increase in interest in the use of statins in oral and maxillofacial surgery. The purpose of this literature review was to look into the effectiveness of statins in this area. Using a set of keywords, a thorough search of electronic databases was carried out, including PubMed, Scopus, Web of Science, Excerpta Medica database (EMBASE), and ProQuest. The papers considered were just those published in the English language between January 2012 and January 2024. Only human studies were taken into consideration; those involving animals were not. For the final analysis that assessed the use of statins in dentistry, a total of 30 papers were chosen. The designs, sample sizes, and materials employed in the experiments varied. According to the research, statins improve bone regeneration, have antiviral and antibacterial qualities, and work well as a therapeutic adjuvant for the treatment of periodontal disease. The analysis of the literature indicates that statins may be beneficial for treating periodontal disease, promoting bone regeneration, and improving oral health in the context of oral and maxillofacial surgery. Nevertheless, more investigation is required to completely comprehend the function of statins in this domain.

Peri-implant bone changes after using platelet-rich fibrin scaffold among Indians

Bone transplant with osteopromotive elements - such as herbal extracts - that promote the creation of new boneis of interest to dentists. Hence, we compared the bone loss around dental implants while placing platelet rich fibrin (PRF) scaffold alone and PRF scaffold with simvastatin (SIM) and PRF scaffold with Moringaoleifera (MO). There were thirty six patients total. A total of 36 implants, or twelve implants in all three categories, were the estimated sample size. Category 1: PRF scaffolds alone. Category 2: PRF scaffolds with SIM. Category 3: PRF scaffolds with MO. Alteration in the bones were measured with CBCT. It was observed that there was decreased loss of crestal bone in PRF+ SIM and PRF+MO as compared to PRF alone. The use of herbal osteopromotive agents like simvastitin and Moringaoleifera along with PRF scaffolds can be effective in reducing bone loss around dental implants.

Effect of simvastatin topical use on alveolar bone after tooth extraction: a scoping review

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.

Chitosan Nanoparticle/Simvastatin for Experimental Maxillary Bony Defect Healing: A Histological and Histomorphometrical Study

Biomaterials such as chitosan and simvastatin (Sim) have been introduced to accelerate the extensive and multicellular biological process of bone healing. The aim of this study was to evaluate the bone healing potential of chitosan and Sim, alone or combined. Forty-two male New Zealand rabbits were divided into three groups: chitosan nanoparticles (ChN), Sim and chitosan simvastatin nanoparticles (ChSimN). Two bony defects were created in the maxillary bone. The hole on the right side received one of the experimental materials, while the other side was assigned as the control and left to heal without any intervention. Bone specimens were collected at 2 and 4 weeks and then taken for histological and histomorphometrical analyses. The histological findings revealed that ChN possessed the highest number of osteoblasts and osteoclasts at weeks 2 and osteocytes after 4 weeks. There was a significant difference between the two healing periods regarding all bone parameters across all groups. ChN stood out as the only group that had a significant difference in the count of all bone cells between the two periods, thus having the best potential in promoting bone healing.

The Effects of Statins on Bone Formation Around Implants Placed in Animal Bones: A Systematic Review and Meta-Analysis

Background

Implants are preferred for replacement of missing teeth by the clinicians as well as the patients. Lesser alveolar bone density doesn't preclude any individual for choosing this option but warrants for extra caution. Preclinical studies have explored the osteoinductive potential of statins, but results should be analyzed vigorously before implementing them in humans. There is no meta-analysis to document effect of statins on bone formation around implants in osteoporotic animals.

Methods and material

PubMed, Embase and Cochrane were searched for studies investigating the effect of statins on bone implant contact (BIC %), bone mineral density (BMD %) and bone volume (BV %) around implants at 2, 4 and 12 weeks. Meta-analysis was performed on subgroups with osteoporotic animals which were administered statins through different routes.

Results

Quantitative data from 12 studies showed favorable effect of statins on bone around implants. Positive difference was observed at 4 weeks in BIC (parenteral [SMD = 4.33 (2.89, 5.77); I 2 = 3%)], BMD (local [SMD = 1.33 (0.51, 2.15); I 2 = 0%] and BV (local [SMD = 1.58 (0.76, 2.40); I 2 = 0%]. BIC [SMD = 1.40 (0.89, 1.90); I 2 = 0%] and BV [SMD = 3.91 (2.33, 5.50); I 2 = 43%] were higher in experimental group after 12 weeks of oral administration.

Conclusions

Statins can be investigated as potential bone graft materials to increase the predictability of osseointegration especially in osteoporotic individuals. Future research should focus to reproduce homogeneous data and conclusive recommendations which can be applied in clinical trials.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-023-01873-z.

Role of various pharmacologic agents in alveolar bone regeneration: A review

Alveolar bone and gingiva are components of the periodontium that house the tooth. It constantly adapts itself to the masticatory forces and position of the tooth. However, localized diseases like chronic periodontitis and certain systemic diseases destroy periodontal tissues, which include the alveolar bone. Various pharmacological agents are being explored for their pleiotropic properties to combat the destruction of alveolar bone. This review focuses on the role of pharmacological agents in alveolar bone regeneration.

Evaluation of efficacy of simvastatin in bone regeneration following local application in third molar extraction socket: A randomized control trial

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.

Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study

Introduction

The study was performed to evaluate and compare the clinical and radiographic efficacy of chlorhexidine (CHX) polymer scaffold, 3Mixtatin, and formocresol for vital primary pulp therapy-a randomized clinical study.

Materials and methods

A total of 120 primary molars were included from children aged between 6 and 8 years in this randomized clinical study based on inclusion and exclusion criteria and were randomly allocated into three groups (group I-CHX polymer scaffold, group II-3Mixtatin, and group III-formocresol. Pulpotomy was performed in a vital cariously exposed primary tooth with healthy periodontium where their retention is more beneficial than extraction. Subjects were followed up at 1, 3, and 6 months for clinical and radiographic evaluations.

Results

At 6 months of follow-up, the overall success rate of pulpotomy in groups I, II, and III was 56.41, 71.05, and 60.52% in each group, respectively. Nonsignificant difference (p > 0.05) was seen during intergroup comparison.

Conclusion

However, among the three materials used in this study, 3mixtatin comparatively had better results.

How to cite this article

Goel N. Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study. Int J Clin Pediatr Dent 2023;16(3):478-482.

Efficacy of spongy xenogeneic scaffold loaded with simvastatin in the treatment of severe alveolar horizontal defect: A clinical and histological study

Background

Bone tissue engineering offers several advantages for repairing skeletal defects. In this study, we designed and fabricated a scaffold for bone tissue engineering in patients with horizontal alveolar defect.

Aim

The items included in the fabrication of the scaffold were xenogenic bone graft, gelatin as a substrate to improve the physical integrity of scaffold, and simvastatin to stimulate osteogenesis (10 mg per 1 g of xenograft).

Methods

Fourteen patients with a horizontal defect in the alveolar ridge were enrolled in the study. Seven patients underwent routinely guided bone regeneration (GBR) using xenogenic bone graft plus collagenous membrane, and seven patients were treated with the scaffolds. After four months of follow-up after surgery, both the scaffold and GBR groups were examined for changes in the width of alveolar ridge and histologically for the quantity of newly produced bone.

Results

The newly designed scaffold showed superior osteoconduction characteristics to routine GBR materials, which were used in this study. The difference in the quantity of the newly produced bone between the scaffold group and GBR group was significant and higher for the scaffold group. Regarding newly produced bone percentage, the scaffold group showed a mean of 20.93 and the GBR group presented a mean of 13.25% (P = 0.004). Also, the mean value for the duration of surgery for GBR was 45 minutes and for scaffold was 22 minutes, which was significantly lower in the scaffold group (P < 0.001).

Conclusions

The newly designed scaffold is a suitable treatment modality for bone tissue engineering.

Pleotropic effects of statins: the dilemma of wider utilization of statin

BACKGROUND

Apart from reducing the circulating LDL-c and the number of cardiovascular cases as well as fatalities, statins have auxiliary non-lipid-related or cholesterol independent effects, the pleiotropic effects. The aim of the present review is to understand the pleotropic effects of statins.

MAIN BODY

Cardiovascular disease (CVD) is presently the major cause of patient misery as well as mortality among non-communicable diseases (NCDs) in the world. Despite the fact that statins are the most extensively affirmed, prescribed and evidence-based lipid-lowering medicine worldwide that curtail low density lipoprotein cholesterol (LDL-c) levels and the number of cardiovascular cases as well as deaths, statins also elicit auxiliary non-lipid-related or cholesterol independent effects, the pleiotropic effects. Improved endothelial function, significantly lowered oxidative stress, atherosclerotic plaque stabilization, immunomodulatory, cessation of vascular smooth muscle proliferation, effects on bone metabolism, anti-inflammatory, antithrombotic effects, and reduced risk of dementia are among these pleotropic effects. Statins have also been explored for its uses in life threatening diseases like cancer and inflammatory bowel disease. They have been demonstrated to revamp vascular tone. Many research and review articles have been thoroughly studied for this systematic review.

CONCLUSIONS

Statins have not only shown to be benefitial in lowering the levels of LDL-C but have also been established to be advantageous in the treatment of cancer, neurological conditions like dementia, multiple sclerosis, inflammatory bowel disease. Future high-quality trials are needed to include statins in the treatment of these conditions as per guidelines.

Effect of Diclofenac and Simvastatin on Bone Defect Healing-An In Vivo Animal Study

Non-steroidal, anti-inflammatory drugs and statins are two widely prescribed drug classes that affect bone formation. The aim of this study was to elucidate the effect of diclofenac and simvastatin in artificial bone defect healing. One hundred and forty-four male Wistar rats were used, and the specimens were divided into groups, with respect to the route of drug administration and the type of defect healing (with or without collagen membrane), and subgroups, with respect to the study duration (2, 4 or 8 weeks). Diclofenac was intramuscularly administered while simvastatin was administered both systemically and locally. Animals were euthanized and specimens were histomorphometrically analyzed to evaluate the percentage of new bone formation (%). Bone healing that occurred without any intervention developed more steadily than that of all other groups. Diclofenac exerted a clear, direct inhibitory effect on bone healing and its systemic administration should be avoided. The systemic administration of simvastatin was related to severe myopathy, while the solvent for the local administration of simvastatin seemed to play significant role in bone growth, as simvastatin, when it is administered intraperitoneally in a DMSO solution, appeared to promote bone healing. Local administration may have a significant impact on bone healing and it should be further investigated with the type of solvent or carrier that is used, which both may play a significant role in bone repair induction.

Potential bioactive coating system for high-performance absorbable magnesium bone implants

Magnesium alloys are considered the most suitable absorbable metals for bone fracture fixation implants. The main challenge in absorbable magnesium alloys is their high corrosion/degradation rate that needs to be controlled. Various coatings have been applied to magnesium alloys to slow down their corrosion rates to match their corrosion rate to the regeneration rate of the bone fracture. In this review, a bioactive coating is proposed to slow down the corrosion rate of magnesium alloys and accelerate the bone fracture healing process. The main aim of the bioactive coatings is to enhance the direct attachment of living tissues and thereby facilitate osteoconduction. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are six bioactive agents that show high potential for developing a bioactive coating system for high-performance absorbable magnesium bone implants. In addition to coating, the substrate itself can be made bioactive by alloying magnesium with calcium, zinc, copper, and manganese that were found to promote bone regeneration.

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Bioactive-coated magnesium implant could accelerate bone fracture healing time to match with magnesium degradation.

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Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are high potential bioactive coating materials.

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The incorporation of Ca, Zn, Cu, Sr, and Mn in Mg base-metal could further enhance bone formation.

The evaluation of cytotoxicity and cytokine IL-6 production of root canal sealers with and without the incorporation of simvastatin: an invitro study

Background

Freshly mixed root canal sealers when proximate the periapical tissues, trigger varying degrees of cytotoxicity/inflammatory reactions. Simvastatin, a class of the drug statin, is a widely used cholesterol-lowering agent with additional anti-inflammatory activities. This study assessed the effects of simvastatin on cytotoxicity and the release of IL-6 (Interleukin-6) production when incorporated in zinc oxide eugenol and methacrylate resin-based sealers.

Methods

Experimental groups consisted of conventional zinc oxide eugenol and methacrylate based-EndoREZ sealers (ZE & ER respectively) and 0.5 mg/mL simvastatin incorporated sealers (ZES & ERS). L929 mouse fibroblast cells were exposed to freshly mixed experimental sealers and evaluated for cytotoxicity (MTT assay) and inflammation levels (inflammatory marker IL-6 for ELISA) at various time intervals (0h, 24h and 7th day). The values were compared to the cell control (CC; L929 cells alone) and solvent control (SC; L929 cells + DMSO) groups. All the experiments were conducted in triplicates and subjected to statistical analysis using IBM SPSS Statistics software. Non parametric tests were conducted using Kruskal-Wallis and Friedman tests for inter-group and intra-group comparisons respectively. Pairwise comparison was conducted by post hoc Dunn test followed by Bonferroni correction. P values < 0.05 were considered statistically significant.

Results

All the experimental groups (ZE, ER, ZES, ERS) exhibited varying degree of cytotoxicity and IL-6 expression compared to the control groups CC and SC. The cell viability for ZE and ER decreased on day 7 as compared to 24 h. ZES and ERS had higher viable cells (75.93% & 79.90%) compared to ZE and ER (54.39% & 57.84%) at all time periods. Increased expression of IL-6 was observed in ZE & ER (25.49 pg/mL & 23.14 pg/mL) when compared to simvastatin incorporated ZE & ER (ZES-12.70 pg/mL & ERS-14.68 pg/mL) at all time periods. Highest level of cytotoxicity and inflammation was observed in ZE compared to all the other groups on day 7.

Conclusions

Addition of 0.5 mg/mL of simvastatin to the sealers (ZES and ERS) decreased the cytotoxicity in the freshly mixed state and reduces their inflammatory effect.

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.

Improvement of Osseointegration by Ultraviolet and/or Simvastatin Treatment on Titanium Implants with or without Bone Graft Materials

We evaluated and compared ultraviolet (UV) treatment and simvastatin (SIM) immersion effects on the osseointegration of sandblasted, large-grit, acid-etched (SLA) titanium dental implants at two different time points in rabbit tibias, with or without xenogenic bone graft materials. The surface alteration on simvastatin treatment titanium discs was analyzed using an infrared spectrometer. Implants were categorized into four groups according to the surface treatment type. Twelve rabbits received two implants per tibia. A tibial defect model was created using a trephine bur, with implants in contact with the bone surface and bovine bone graft materials for gap filling. The rabbits were sacrificed after 2 or 4 weeks. UV treatment or SIM immersion increased the bone-to-implant contact (BIC) on nongrafted sides, and both increased the BIC and bone area (BA) on grafted sides. The application of both treatments did not result in higher BIC or BA than a single treatment. At two different time points, BIC in the nongrafted sides did not differ significantly among the UV and/or SIM treated groups, whereas BA differed significantly. UV or SIM treatment of SLA titanium implants accelerates osseointegration in tibias with or without xenogenic bone graft materials. The combination of both treatments did not show synergy.

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.

Potential Bone Regenerative Effects of DFDBA, Simvastatin and Platelet Rich Fibrin, Radiographically and Histologically of Intra-Bony Periodontal Defects in White New Zealand Rabbits

AIM: This study aimed to evaluate and to compare the regenerative power of simvastatin, Demineralized Freeze-Dried Bone Allograft (DFDBA) allograft, platelets rich Fibrin (PRF), and a combination of these materials radiographically and histologically in the intra-bony periodontal defects in white New Zealand rabbits. MATERIALS AND METHODS: This study was conducted on 54 defects in 27 adult male rabbits (n = 27) which were divided into three groups according to the follow-up preplanned scheduled for 1, 2, and 3 weeks. The selected materials were induced as following: A=DFDBA, B=Simvastatin, C= PRF, D=A+C, E=B+C, and F=negative (control group). The intra-bony periodontal defects were induced as the form of one osseous wall defect of 10 mm height, 4 mm depth between the first and the second molars. Then, samples were prepared for histological evaluation. Radiographic assessment was done using computed tomography radiography which was carried at different time intervals as the following baseline, 1, 2, and 3 weeks later. Statistical analysis was performed using ANOVA. RESULTS: After evaluating the results, macroanatomy, radiographically, and histologically, it is thus confirmed that DFDBA allograft combined with PRF create the best bone regenerative results, followed by DFDBA, Simvastatin, simvastatin+ PRF, control group, and finally PRF. CONCLUSION: All of the materials examined in this study showed different percentage in terms of bone density and bone regenerative effects. However, the best results for bone density of the DFDBA + PRF group were recorded after 3 weeks. Thus, the study concludes that a combination of DFDBA + PRF reflects the best properties of both materials in terms of bone density results of the defect. Such results are particularly significant for the selection of bone regeneration materials, and generally, for periodontal regeneration.

Medication-Related Osteonecrosis of the Jaw (MRONJ) due to Simvastatin: An Unusual Case Report

Medication-related osteonecrosis of the jaw (MRONJ) is a serious pathological condition that usually results from anti-resorptive or anti-angiogenic drugs. We aimed to report an unusual MRONJ in a female patient due to long-term simvastatin administration. A 48-year female was referred to the Department of Oral and Maxillofacial, Mashhad Dental School, Mashhad, Iran in Dec 2019. She complained of pain, swelling, and infection in the right mandibular area with a history of extraction. Based on medical history, the patient received 40 mg of simvastatin daily for ten years to control hypercholesterolemia. According to clinical and radiographic examinations, as well as previous medical and dental records, the lesion diagnosis was detected as MRONJ. Moreover, histopathological examination of the lesion confirmed our clinical diagnosis. The necrotic bone was removed with caution. The PRF was then inserted, and the flap was sutured without any tension. No complications were observed on following-up, and all symptoms were discontinued. There was a correlation between the administration of high-dose simvastatin and MRONJ. Moreover, more clinical investigation with larger sample sizes is suggested.

Preclinical and Clinical Applications of Biomaterials in the Enhancement of Wound Healing in Oral Surgery: An Overview of the Available Reviews

Oral surgery has undergone dramatic developments in recent years due to the use of biomaterials. The aim of the present review is to provide a general overview of the current biomaterials used in oral surgery and to comprehensively outline their impact on post-operative wound healing. A search in Medline was performed, including hand searching. Combinations of searching terms and several criteria were applied for study identification, selection, and inclusion. The literature was searched for reviews published up to July 2020. Reviews evaluating the clinical and histological effects of biomaterials on post-operative wound healing in oral surgical procedures were included. Review selection was performed by two independent reviewers. Disagreements were resolved by a third reviewer, and 41 reviews were included in the final selection. The selected papers covered a wide range of biomaterials such as stem cells, bone grafts, and growth factors. Bioengineering and biomaterials development represent one of the most promising perspectives for the future of oral surgery. In particular, stem cells and growth factors are polarizing the focus of this ever-evolving field, continuously improving standard surgical techniques, and granting access to new approaches.

Osteogenic effects in a rat osteoporosis model and femur defect model by simvastatin microcrystals

Simvastatin is a translational drug that may be used to induce local bone formation. In this study, simvastatin microcrystals were made by a wet media milling method, and then we verified the osteogenic effect of the microcrystals in rat ovariectomy (OVX)-induced osteoporosis and femur defect models. For the osteoporosis model, we delivered simvastatin microcrystals to the tibia with poloxamer hydrogels via an intraosseous injection. Bone mineral density and the ultimate force of the treated tibia were significantly improved after injection of simvastatin microcrystals at 0.5 and 1 mg compared with the OVX or 0-mg control groups. For the femur defect model, simvastatin microcrystals were incorporated in clinically used calcium phosphate cements (CPCs) as an implant. Quantitative analysis of bone regeneration by microcomputed tomography (μCT) showed improved bone morphology with simvastatin microcrystals at 50 and 100 μg, compared with the CPC vehicle. A semiquantitative scale for histology assessment further demonstrated a higher bone regeneration score in the drug-loaded groups. Our study shows that simvastatin microcrystals can promote bone formation by local delivery using a poloxamer hydrogel or CPC, which may be translationally useful.

Small molecule compounds promote the proliferation of chondrocytes and chondrogenic differentiation of stem cells in cartilage tissue engineering

The application of tissue engineering to generate cartilage is limited because of low proliferative ability and unstable phenotype of chondrocytes. The sources of cartilage seed cells are mainly chondrocytes and stem cells. A variety of methods have been used to obtain large numbers of chondrocytes, including increasing chondrocyte proliferation and stem cell chondrogenic differentiation via cytokines, genes, and proteins. Natural or synthetic small molecule compounds can provide a simple and effective method to promote chondrocyte proliferation, maintain a stable chondrocyte phenotype, and promote stem cell chondrogenic differentiation. Therefore, the study of small molecule compounds is of great importance for cartilage tissue engineering. Herein, we review a series of small molecule compounds and their mechanisms that can promote chondrocyte proliferation, maintain chondrocyte phenotype, or induce stem cell chondrogenesis. The studies in this field represent significant contributions to the research in cartilage tissue engineering and regenerative medicine.

Stimulatory effects of simvastatin on bone regeneration of the expanded suture in rats

Simvastatin belongs to the family of statins and is found to have some osteopromotive properties in recent years. The aim of the present study was to investigate the potential effects of simvastatin on bone formation of the expanded mid-palatal suture of rats. Forty-five Wistar rats were randomly divided into three groups: control (C), expansion (EP), and expansion plus simvastatin (ES) groups. Rats in the ES group were administrated with simvastatin (20 mg/kg/d body weight). According to the schedule of sacrifice (days 3, 7 and 14), the suture width and bone volume changes of the region of interest (ROI) were detected by micro-computed tomography during RME. Besides, morphological changes and bone morphogenetic protein 2 (BMP-2) expression in the mid-palatal suture were observed by hematoxylin and eosin (HE) and immunohistochemical staining. Kruskal-Wallis one-way analysis of variance (ANOVA) and LSD method were applied to analyze the data at P<0.05 level. By the RME appliance, the suture was successfully widened. On days 7, 14, the bone volume of ROI in the ES group was more than that in the EP group (P<0.05). Besides, histological examinations also demonstrated that more bone regeneration and capillaries in the suture in the ES group were observed than that in the EP group. The BMP-2 expression in the ES group was more (P<0.05) than that in the EP and C groups on days 3, 7, 14. Consequently, those findings showed that simvastatin can induce a favorable effect on bone regeneration in the mid-palatal suture of rats during RME.

The promotion of bone regeneration through CS/GP-CTH/antagomir-133a/b sustained release system

Few studies reported the application of miRNA in bone regeneration. In this study, the expression of miR133a and miR133b in murine BMSCs was inhibited via antagomiR-133a/b and the osteogenic differentiation in murine BMSCs was evaluated. The RT-PCR, flow cytometry, cell counting kit-8, and annexin V-FITC/PI double staining assays were performed. Double knockdown miR133a and miR133b can promote BMSC osteogenic differentiation. At optimum N/P ration (15:1), the loading efficiency can reach over 90%. CTH-antagomiR-133a/b showed no cytotoxicity to BMSCs and diminished miR133a and miR133b expression in BMSCs. Furthermore, chitosan-based sustained delivery system can facilitate continuous dosing of antagomiR-133a/b, which enhanced calcium deposition and osteogenic specific gene expression in vitro. The new bone formation was enhanced after the sustained delivery system containing CTH-antagomiR-133a/b nanoparticles was used in mouse calvarial bone defect model. Our results demonstrate that CTH nanoparticles could facilitate continuous dosing of antagomiR133a/b, which can promote osteogenic differentiation.