Efficacy of simvastatin in bone regeneration after surgical removal of mandibular third molars

Simvastatin is delivered to the brain by high-strength intranasal cationic SMEDDS and nanoemulsions

The repurposing of statins as neuroprotective agents and/or anti-brain tumor drugs is limited by challenges in brain bioavailability and systemic off-target effects. Therefore, improved and targeted delivery of statins to the brain is necessary. This study aimed to develop a high-strength liquid formulation of the poorly soluble prodrug simvastatin for intranasal administration, as a strategy to achieve high brain concentrations of the prodrug and/or its active form, tenivastatin. Cationic simvastatin nanoemulsions (c-NE) and self-microemulsifying drug delivery systems (c-SMEDDS) were screened for composition, extensively characterized, and the viscosity of the nanoemulsion was further optimized. The optimized c-NE and c-SMEDDS formulations achieved high drug strengths, approximately 5.5% and 9% (w/w), respectively. They formed highly homogeneous aqueous dispersions (polydispersity index < 0.1) with small droplet sizes (< 120 nm and ~ 25 nm, respectively) and remained stable for at least four months under refrigeration. Neither the c-NE nor the c-SMEDDS induced hemolysis up to concentrations of 40 µg/mL and 450 µg/mL of simvastatin, respectively. The zero-shear viscosity of the c-NE was increased to 186 mPa·s by incorporating 0.25% (w/w) polyvinylpyrrolidone, which approached the viscosity of the c-SMEDDS (~ 126 mPa·s). Following intranasal administration of the optimized formulations to Wistar rats at a dose of 10 mg/kg, simvastatin levels in the brain reached 50 to 150 ng/g between 15 and 60 min post-administration. These findings indicate that the developed c-NE and c-SMEDDS formulations hold promise for simvastatin intranasal delivery and brain targeting, potentially paving the way for the realization of simvastatin's neuroprotective potential.

Role of Statins in Oral and Maxillofacial Surgery: A Literature Review

In recent years, there has been a notable increase in interest in the use of statins in oral and maxillofacial surgery. The purpose of this literature review was to look into the effectiveness of statins in this area. Using a set of keywords, a thorough search of electronic databases was carried out, including PubMed, Scopus, Web of Science, Excerpta Medica database (EMBASE), and ProQuest. The papers considered were just those published in the English language between January 2012 and January 2024. Only human studies were taken into consideration; those involving animals were not. For the final analysis that assessed the use of statins in dentistry, a total of 30 papers were chosen. The designs, sample sizes, and materials employed in the experiments varied. According to the research, statins improve bone regeneration, have antiviral and antibacterial qualities, and work well as a therapeutic adjuvant for the treatment of periodontal disease. The analysis of the literature indicates that statins may be beneficial for treating periodontal disease, promoting bone regeneration, and improving oral health in the context of oral and maxillofacial surgery. Nevertheless, more investigation is required to completely comprehend the function of statins in this domain.

Effect of simvastatin topical use on alveolar bone after tooth extraction: a scoping review

OBJECTIVES

Conducting a scoping review (SR) to assess scientific evidence for topical simvastatin's impact on alveolar bone regeneration and determine its level of support for clinical applications.

MATERIALS AND METHODS

This SR followed the PRISMA-ScR and OSF registries protocol; systematic searching was conducted on MEDLINE/PubMed, Cochrane, Embase, Scopus, Web of Science, and LILACS, to identify relevant articles until June 2023. Inclusion criteria covered clinical trials, case series, prospective and retrospective studies, along with in vivo investigations, involving participants of any sex and age.

RESULTS

Out of 1312 identified studies, 20 (9 in vivo, 11 RCTs) met inclusion criteria. RCTs focused on third molar extraction, in vivo on mandibular incisor surgery. The majority of RCTs employed a collagen sponge and a simvastatin concentration of 10mg; conversely, most in vivo studies favored polylactide-co-glycolide and a 2 mg simvastatin concentration. RCTs had 3-month follow-ups; in vivo, studies extended to 8 weeks. Seven RCTs assessed pain outcomes, simvastatin did not significantly affect pain in six studies. Among four RCTs on postoperative swelling, only two observed a significant increase in the simvastatin group. In general, positive bone formation and the absence of adverse effects directly linked to topical simvastatin were observed across the study models.

CONCLUSIONS

Intra-alveolar simvastatin post-tooth extraction has been to be shown to be effective and safe for preserving alveolar bone, with varied concentrations and carriers, with no significant adverse effects.

CLINICAL RELEVANCE

This review provides critical insights into the effects of simvastatin on alveolar bone regeneration, informing potential benefits and possible challenges associated with its post-extraction application. OSF REGISTRY PROTOCOL: osf.io/q3bnf.