Locally Delivered 1.2% Simvastatin Gel and 1% Metformin Gel in Chronic Periodontitis Patients

Abstract

Background: This study was carried out to investigate the effectiveness of 1.2% Simvastatin gel and 1% Metformin gel in chronic periodontitis pockets. The rationale behind using Statins is that this class of drugs has a potential anti-inflammatory effect on oral epithelial cells, blocking the intermediate metabolites of the mevalonate pathway. Statins also modulate bone formation by increasing the expression of bone morphogenetic protein-2 providing a new direction in the field of periodontal therapy. Statin administration decreases GCF levels of pro-inflammatory mediators which are responsible for much of the host tissue destruction seen in periodontitis. Metformin acts at molecular level via both AMPK (5’adenosine monophosphate activated protein kinase) dependent & AMPK independent pathways. It shows effects on Nuclear Factor-κB (NF-κB), differentiation of monocytes into macrophages as well as suppressing IL-2, interferon (IFN)-γ and TNF-α from these macrophages which thereby improved the periodontal clinical parameters. There is no evidence of literature till now comparing the clinical efficacy of 1.2% Simvastatin gel with 1% Metformin gel in patients with chronic periodontitis. Method: The study population consisted of 48 sites from chronic periodontitis patients, divided into 3 groups which received sub gingival irrigation with Scaling and root planning alone, SRP with 1.2% Simvastatin gel and SRP with1% Metformin gel. Results: 1.2% Simvastatin gel and 1% Metformin gel improve the periodontal health with statistically significant improvement in the PPD, RAL, RGML values as compared to SRP alone. Conclusion: LDD systems using gel formulations are advantageous because of their sustainability, prolonged release, stability in the pockets, clinical effect of 1.2% Simvastatin gel and 1% Metformin gel improves the periodontal health compared to SRP alone.