Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.
Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.
J Periodontal Res. 2018 Jun;53(3):267-287. doi: 10.1111/jre.12514. Epub 2017 Dec 6.
The cholesterol-lowering drugs, statins, possess anti-inflammatory, antimicrobial and pro-osteogenic properties, and thus have been tested as an adjunct to periodontal treatment. The present systematic review aimed to answer the following focused research question: What is the effect of local and/or systemic statin use on periodontal tissues in preclinical in vivo studies of experimentally induced periodontitis (EIP) and/or acute/chronified periodontal defect (ACP) models? A literature search (of Medline/PubMed, Embase/Ovid, CENTRAL/Ovid) using the following main eligibility criteria was performed: (i) English or German language; (ii) controlled preclinical in vivo trials; (iii) local and/or systemic statin use in EIP and/or ACP models; and (iv) quantitative evaluation of periodontal tissues (i.e., alveolar bone level/amount, attachment level, cementum formation, periodontal ligament formation). Sixteen studies in EIP models and 7 studies in ACP models evaluated simvastatin, atorvastatin or rosuvastatin. Thirteen of the EIP (81%) and 2 of the ACP (29%) studies presented significantly better results in terms of alveolar bone level/amount in favor of statins. Meta-analysis based on 14 EIP trials confirmed a significant benefit of local and systemic statin use (P < .001) in terms of alveolar bone level/amount; meta-regression revealed that statin type exhibited a significant effect (P = .014) in favor of atorvastatin. Three studies reported a significantly higher periodontal attachment level in favor of statin use (P < .001). Complete periodontal regeneration was never observed; furthermore, statins did not exert any apparent effect on cementum formation. Neither local nor systemic use of statins resulted in severe adverse effects. Statin use in periodontal indications has a positive effect on periodontal tissue parameters, supporting the positive results already observed in clinical trials. Nevertheless, not all statins available have been tested so far, and further research is needed to identify the maximum effective concentration/dose and optimal carrier.
降胆固醇药物他汀类药物具有抗炎、抗菌和促骨生成特性，因此已被测试作为牙周治疗的辅助手段。本系统评价旨在回答以下聚焦研究问题：在实验性牙周炎（EIP）和/或急性/慢性牙周缺损（ACP）模型的临床前体内研究中，局部和/或全身使用他汀类药物对牙周组织有什么影响？使用以下主要纳入标准进行了文献检索（Medline/PubMed、Embase/Ovid、CENTRAL/Ovid）：（i）英语或德语；（ii）对照性临床前体内试验；（iii）EIP 和/或 ACP 模型中局部和/或全身使用他汀类药物；（iv）牙周组织的定量评估（即牙槽骨水平/量、附着水平、牙骨质形成、牙周韧带形成）。16 项 EIP 模型研究和 7 项 ACP 模型研究评估了辛伐他汀、阿托伐他汀或罗苏伐他汀。13 项 EIP 研究（81%）和 2 项 ACP 研究（29%）在牙槽骨水平/量方面呈现出更有利于他汀类药物的显著更好结果。基于 14 项 EIP 试验的荟萃分析证实了局部和全身使用他汀类药物在牙槽骨水平/量方面的显著益处（P <.001）；元回归显示他汀类药物类型具有显著影响（P =.014），有利于阿托伐他汀。三项研究报告称，使用他汀类药物有利于牙周附着水平显著提高（P <.001）。从未观察到完全的牙周再生；此外，他汀类药物对牙骨质形成没有明显影响。局部和全身使用他汀类药物均未产生严重不良反应。在牙周适应证中使用他汀类药物对牙周组织参数有积极影响，支持已在临床试验中观察到的积极结果。然而，目前尚未测试所有可用的他汀类药物，需要进一步研究以确定最大有效浓度/剂量和最佳载体。
