Department of Periodontology, Guarulhos University, Rua Nilo Peçanha, 68, Guarulhos, SP, Brazil.
Stomatology Department School of Medicine and Dentistry, University of Valencia, Valencia, Spain.
Clin Oral Investig. 2018 Sep;22(7):2413-2430. doi: 10.1007/s00784-018-2507-x. Epub 2018 Jun 12.
This review aimed at evaluating the effects of chronic periodontitis (CP) treatment with local statins as adjuncts to scaling and root planing (SRP), compared with SRP alone or with placebo.
Electronic and hand searches were conducted in three databases to select randomized controlled trials (RCTs) comparing SRP + statins versus SRP alone. Random effects models were conducted to determine the clinical attachment level (CAL) gain as the primary outcome variable, and probing pocket depth (PPD) reduction, modified sulcus bleeding index (mSBI), and intrabony defect depth (IBD) as the secondary outcomes.
Of the 526 papers identified, 15 articles met the criteria for inclusion in this systematic review, and 13 in the meta-analysis. The meta-analysis showed a statistically significant CAL gain (mean differences [MD] = 1.84 mm, 95% confidence interval [CI] = 1.45 to 2.23; p = 0.000), PPD reduction (MD = 1.69 mm, 95% CI = 1.37 to 2.04; p = 0.000), mSBI change (MD = 0.70, 95% CI = 0.57 to 0.84; p = 0.000), and IBD (MD = 1.48, 95% CI = 1.30 to 1.67; p = 0.000) attributed to SRP + statin treatment (6 months).
Within the limitations of this study, the collective evidence emerging from this systematic review and meta-analysis may support the use of locally applied statins as adjuncts to SRP in CP treatment, based on being an easy, low-cost alternative, with lesser adverse effects on bacterial resistance. These results should be interpreted with caution.
Clinicians might consider the use of SRP + statins as an adjunct over other alternative approaches, based on the results of the present review. The informed decision should be taken, considering the patient's values and preferences, and the intervention to be implemented by the clinician.
本综述旨在评估慢性牙周炎（CP）患者在接受牙周基础治疗（SRP）的同时局部应用他汀类药物辅助治疗（与单纯 SRP 或安慰剂相比）的效果。
通过电子和手工检索在三个数据库中选择比较 SRP+他汀类药物与单纯 SRP 的随机对照试验（RCT）。采用随机效应模型确定临床附着水平（CAL）的获得作为主要结局变量，探查袋深度（PPD）减少、改良龈沟出血指数（mSBI）和骨内缺损深度（IBD）作为次要结局。
在确定的 526 篇文献中，有 15 篇文章符合纳入本系统综述的标准，有 13 篇文章纳入荟萃分析。荟萃分析显示，CAL 获得（均值差值 [MD] = 1.84mm，95%置信区间 [CI] = 1.45 至 2.23；p = 0.000）、PPD 减少（MD = 1.69mm，95%CI = 1.37 至 2.04；p = 0.000）、mSBI 变化（MD = 0.70，95%CI = 0.57 至 0.84；p = 0.000）和 IBD（MD = 1.48，95%CI = 1.30 至 1.67；p = 0.000）与 SRP+他汀类药物治疗（6 个月）相关。
在本研究的限制范围内，本系统综述和荟萃分析的综合证据可能支持局部应用他汀类药物作为 CP 治疗中 SRP 的辅助治疗方法，因为它是一种简单、低成本的替代方法，对细菌耐药性的不良影响较小。这些结果应谨慎解释。
根据本综述的结果，临床医生可能会考虑将 SRP+他汀类药物作为其他替代方法的辅助手段。在做出决策时，应考虑患者的价值观和偏好，以及临床医生将要实施的干预措施。
