Efficacy of locally-delivered statins adjunct to non-surgical periodontal therapy for chronic periodontitis: a Bayesian network analysis

Mianfeng Yao,Qiulan Li,Hongbo Zhou,Ruoyan Cao,Qiqi Wu,Yu Chen

doi:10.1186/s12903-019-0789-2

Mianfeng Yao, Qiulan Li + Show 4 more

Open Access

https://doi.org/10.1186/s12903-019-0789-2

Copy DOI

Abstract

BackgroundStudies indicate locally-delivered statins offer additional benefits to scaling and root planning (SRP), however, it is still hard to say which type of statins is better. This network meta-analysis aimed to assess the effect of locally-delivered statins and rank the most efficacious statin for treating chronic periodontitis (CP) in combination with SRP.MethodsWe screened four literature databases (Pubmed, Embase, Cochrane Library, and Web of Science) for randomized controlled clinical trials (RCTs) published up to June 2018 that compared different statins in the treatment of chronic periodontitis. The outcomes analyzed were changes in intrabony defect depth (IBD), pocket depth (PD), and clinical attachment level (CAL). We carried out Bayesian network meta-analysis of CP without systemic diseases. Traditional and Bayesian network meta-analyses were conducted using random-effects models.ResultsGreater filling of IBD, reduction in PD, and gain in CAL were observed for SRP treated in combination with statins when compared to SRP alone for treating CP without systemic diseases. Specifically, SRP+ Atorvastatin (ATV) (mean difference [MD]: 1.5 mm, 1.4 mm, 1.8 mm, respectively), SRP + Rosuvastatin (RSV) (MD: 1.8 mm, 2.0 mm, 2.1 mm, respectively), and SRP + Simvastatin (SMV) (MD: 1.1 mm, 2.2 mm, 2.1 mm, respectively) were identified. However, no difference was found among the statins tested. In CP patients with type 2 diabetic (T2DM) or in smokers, additional benefits were observed from locally delivered statins.ConclusionLocal statin use adjunctive to SRP confers additional benefits in treating CP by SRP, even in T2DM and smokers. RSV may be the best one to fill in IBD. However, considering the limitations of this study, clinicians must use cautious when applying the results and further studies are required to explore the efficacy of statins in CP with or without the risk factors (T2DM comorbidity or smoking history).

Highlights

Studies indicate locally-delivered statins offer additional benefits to scaling and root planning (SRP), it is still hard to say which type of statins is better
Chronic periodontitis (CP) is a multifactorial inflammatory disease caused by pathogenic microorganisms and disordered host immune inflammation that leads to bone resorption, bony defects, and tooth loss [1]
Exclusion criteria Studies that had any of the following characteristics were excluded: (a) split-mouth Randomized controlled clinical trial (RCT) design; (b) inclusion patients with statin allergy; (c) application of systemic statin therapy; (d) inclusion of immunocompromised individuals; (e) inclusion of former smokers; (f ) systemic diseases except for type 2 diabetes

Summary

Introduction

Studies indicate locally-delivered statins offer additional benefits to scaling and root planning (SRP), it is still hard to say which type of statins is better. This network meta-analysis aimed to assess the effect of locally-delivered statins and rank the most efficacious statin for treating chronic periodontitis (CP) in combination with SRP. Cao et al BMC Oral Health (2019) 19:105 diseases This phenomenon may be due to the unique properties of statins that limit the pathogenesis of periodontitis, such as anti-inflammatory [7, 8], antimicrobial [9], bone formation promoting, bone loss inhibiting [10, 11] and antioxidant properties [12]. A network meta-analysis which compares and ranks different statins should be beneficial to clinical practice

Methods

Results

Discussion

Conclusion