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Health See other Health Articles Title: Statin Gel Shows Promise for Periodontitis Atorvastatin gel applied locally may reduce symptoms of periodontitis and stimulate bone growth in defects caused by the disease, according to the results of a new randomized trial. Patients treated with atorvastatin gel combined with scaling and root planing had 35.49% (±5.50%) mean radiographic bone fill compared with only 1.82% (±1.32%) in patients who received scaling and root planing and a placebo gel, researchers report in an article published online October 2 in the Journal of Periodontology. "This can provide a new direction in the management of intrabony defects in chronic periodontitis," A. R. Pradeep, MDS, from the Department of Periodontics, Government Dental College & Research Institute, Bangalore, India, and colleagues write. Periodontists have long sought an alternative to surgery for the bony defects, but so far nothing has proven as effective as placing bone particles or substitutes into the defects to stimulate host bone formation. Researchers thought of using statins after noticing that patients receiving chronic statin therapy seemed to have less severe periodontitis than similar patients who were not receiving the drugs. In addition to controlling cholesterol, statins have anti-inflammatory, immunomodulatory, antioxidant, antithrombotic, and endothelium stabilization effects and can promote angiogenesis and osteoblastic differentiation, Dr. Pradeep and colleagues note. Retrospective studies confirmed that patients receiving simvastatin or atorvastatin had lower indexes of probing than other patients, and one study showed that atorvastatin could prevent alveolar bone loss in rats with ligature-induced periodontitis. In addition, in 2010, a small randomized controlled trial of systemic atorvastatin published in the Journal of Clinical Periodontology showed reductions in tooth mobility and the distance from the crestal alveolar bone to the cemento-enamel junction. Dr. Pradeep and colleagues wanted to see whether applying the drug locally could provide even bigger benefits, so they mixed a biocompatible solvent into methylcellulose to create a gel and then added atorvastatin to a final concentration of 1.2%. They recruited 67 patients with severe chronic periodontitis and randomly assigned them to scaling and root planing plus the atorvastatin gel or to scaling and root planing plus a placebo gel. Sixty of these patients finished the trial. The researchers injected the gels into the periodontal pockets with syringes with blunt cannulas. They instructed the patients to refrain from chewing hard or sticky foods, brushing near the treated areas, or using any interdental aids for a week. At baseline, 6, and 9 months, they assessed the depth of bone fill by taking X-rays and then using software to measure the vertical distance from the crest of the alveolar bone to the base of the defect shown on these images. They also measured plaque, probing depth, clinical attachment level, and sulcus bleeding. At 9 months, they found a mean probing depth of 4.07 (±1.01) mm in the atorvastatin group compared with 6.27 (±0.95) mm in the placebo group, which is a statistically significant difference (P < .001). Clinical attachment level was 2.57 (±0.86) mm in the atorvastatin group compared with 5.13 (±0.73) mm (P < .001). The modified sulcus bleeding index was 1.13 (±0.23) for atorvastatin vs 1.61 (±0.16) for placebo (P = .000). The full-mouth plaque index was 0.68 (±0.31) for atorvastatin vs 0.74 (±0.26) for placebo, which was not a statistically significant difference (P = .413). The intrabony defect was 3.09 (±0.40) for atorvastatin vs 4.67 (±0.51) for placebo (P < .001). Although the results are positive, the researchers caution against drawing firm conclusions from these results until a long-term, multicenter, randomized controlled clinical trial is done. Nancy Newhouse, DDS, an assistant clinical professor at the University of Missouri in Kansas City and president of the American Academy of Periodontology, agreed with the researchers' conclusions. "I think it shows promise," she told Medscape Medical News. "They looked at only 60 patients, and there was only one site in each patient, so it's a small clinical trial and there has to be some follow-up," added Dr. Newhouse, who was not associated with the study. Dr. Newhouse and the authors of the study have disclosed no relevant financial relationships. J Periodontol. Posted online October 2, 2012. Abstract Post Comment Private Reply Ignore Thread
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