A CLINICAL, RADIOLOGICAL AND IL-6 EVALUATION OF SUBGINGIVALLY DELIVERED SIMVASTATIN IN THE TREATMENT OF CHRONIC PERIODONTITIS

Abstract

Simvastatin (SMV) are specific competitive inhibitors which are widely used to lower cholesterol for the treatment of hyperlipidemia and arteriosclerosis. They have shown to modulate bone formation by increasing the expression of bone morphogenetic protein-2, inflammation, and angiogenesis,3 thus providing a new direction in the field of periodontal therapy. The aim of this randomized trial was to assess the clinical and radiographic effects of 1.2% Simvastatin  gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis. The IL-6 level in the sulcular epithelium was also evaluated before and after treatment with 1.2% simvastatin. 60 sites were selected with minimum one intrabony defect and probing pocket depth of >5mm and were divided into 2 groups; 30 sites were treated with SRP and placebo (Group A) and 30 sites were treated with SRP along with Simvastatin (SMV) (group B). Clinical parameters recorded at baseline before SRP and at 60 th , 90 th and 180 th day; included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). Radiologic assessment of intrabony defect (IBD) fill was done at baseline and after 6 months using computer-aided software. Interleukin-6-mRNA (IL-6-mRNA) levels in sulcular epithelium was analysed for Group B at baseline and 3 months after the drug application. Both therapies resulted in significant improvements in the parameters however SRP along with simvastatin showed statistically significant decrease in PI, mSBI and PD and gain in CAL at 6 months. In Group B, there was greater decrease in mean IBD as compared to Group A. At the molecular level the simvastatin group showed a significant decrease in IL-6-mRNA levels. The statistically significant improvement in clinical and hard tissue parameters at sites treated with SRP plus locally delivered SMV as well as its potency in reducing IL-6-mRNA levels proved the efficacy of  the drug as a local drug delivery system in the treatment of chronic periodontitis not only in clinical but as well as in molecular level.