The impact of simvastatin intervention on the healing of bone, soft tissue, and TMJ cartilage in dentistry: a systematic review and meta-analysis

Abstract

The review aimed at assessing the osteopromotive potential as well as soft tissue and temporomandibular joint (TMJ) cartilage healing properties of simvastatin by summarizing its efficacy on the current dental treatment of periodontal bone and soft tissue defects, and temporomandibular joint (TMJ) arthritis from the available animals and human studies. An electronic search was performed on MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) using a combination of keywords. A hand search was undertaken on seven oral surgery journals. No limitation of publication year in the English language was placed. Controlled randomized animal and human clinical trials, as well as prospective comparative studies, were included. Data on the comparison of topical/systemic simvastatin on bone healing in intrabony and furcation defects, extraction sockets, distraction osteogenesis, as well as soft tissue healing in mucogingival grafting procedures and cartilage protection in TMJ arthritis were extracted from all the eligible studies. Studies with a minimum of ten participants and follow up at least 6 months were included. Ten animal studies and six clinical studies were included in this study. All the animal studies included a minimum of eight sites per group assessed clinically, histologically, and radiographically. All human studies included clinical and radiological evaluation. The results of the review show that simvastatin administration displays positive treatment outcomes in the full range of therapies investigated in the oral regions such as periodontal infection control, periodontal and alveolar bone regeneration, soft tissue grafting, TMJ inflammation reduction, and cartilage repair. Its mechanism includes stimulating bone formation, promoting soft tissue healing, increasing articular and condylar cartilage thickness, as well as reducing inflammation at surgical sites in TMJ disorders. Simvastatin administration is beneficial to the healing of oral bone and cartilage. More studies are desired to determine its potential in soft tissue healing.

Medication-Related Osteonecrosis of the Jaw (MRONJ) due to Simvastatin: An Unusual Case Report

“…10 In other words, both BPs and simvastatin can block the mevalonate pathway and have a similar effect on osteoclasts, even though they impact different enzymes. 5,9,10 Long-term use of simvastatin might cause osteonecrosis of the jaw, similar to the present case. Two cases of maxillary MRONJ were reported in healthy and non-smoker patients who undertook high-doses of simvastatin for 20 years.…”

“…[1][2][3][4][5] Simvastatin is a cholesterol-lowering drug with some therapeutic effects on bone angiogenesis. 9 It appears to play a significant role in bone regeneration by directly participating in osteoblast activation as well as osteoclast inhibition. 9 Statins drugs inhibit the mevalonate pathway by inhibiting HMG-CoA reductase.…”

“… 9 It appears to play a significant role in bone regeneration by directly participating in osteoblast activation as well as osteoclast inhibition. 9 Statins drugs inhibit the mevalonate pathway by inhibiting HMG-CoA reductase. 10 In other words, both BPs and simvastatin can block the mevalonate pathway and have a similar effect on osteoclasts, even though they impact different enzymes.…”

Osteogenic effects in a rat osteoporosis model and femur defect model by simvastatin microcrystals

“…Approaches to regenerate bone include specific grafting surgical techniques with autogenous bone, substitutes, barrier membranes, growth factors, stem cell therapy, and, lately, osteopromotive pharmacological compounds. Pharmacological approaches have gained in popularity owing to their convenience and advantageous cost‐effectiveness when applied with other grafting techniques 21 . A number of studies have demonstrated that simvastatin can significantly increase bone formation 7,17 .…”

Osteogenic effect in rat osteoporosis model and femur defect model by intraosseous administration of simvastatin microcrystals

“…The pharmacological approaches have gained popularity owing to their convenience and the advantageous cost-effectiveness when applied with other grafting techniques. [19] A number of studies have demonstrated that simvastatin can significantly increase bone formation. [7,15] In addition to direct effect on osteoblasts and osteoclast, the underlying mechanisms are complexed by statins' pleiotropic effects including anti-inflammation, angiogenesis and antibacterial activity which could also play an important role in bone formation.…”