Comparative Evaluation of the Alveolar Ridge Preservation Following Intra Alveolar Extraction of Maxillary and Mandibular Molars With and Without the Use of Local Simvastatin: A Randomized Clinical Study.

Statins are specific inhibitors of 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) reductase which is involved in the conversion of HMG-CoA to mevalonate, thus reducing the hepatic synthesis of cholesterol. Simvastatin is a chemically modified statin that stimulates bone formation by increasing the gene expression of bone morphogenetic protein-2 (BMP 2) and vascular endothelial growth factor (VEGF). The time of extraction is the best time to preserve the alveolar ridge. Ridge preservation can prevent 40%–60% of the jaw bone atrophy that normally happens 2–3 years after tooth extraction. Simvastatin can be topically or systemically administered to take advantage of its anabolic effects on bone. Systemically administered simvastatin has less than 5% bioavailability due to high first pass metabolism in the liver. Hence local drug delivery systems are used to directly deliver simvastatin to the site of action. The existing methods of ridge preservation include the use of autogenous, allogenic, xenogenous grafts, and alloplasts. Autogenous bone offers osteoinduction, osteogenicity and an osteoconductive matrix that are necessary for bone repair. But disadvantages like, a second surgical site, donor site morbidity, stability of graft, storage, post-operative discomfort and increased surgical time subsequently led to the development of various alternatives like pharmacologic compounds such as simvastatin that can upregulate the necessary autogenous growth factors and will be a cost-effective way to correct bone defects. Simvastatin packed locally in extraction sockets is safe, painless, inexpensive with no side effects and improved tissue repair. This study is designed prospectively to radiographically assess the alveolar ridge preservation following intra alveolar extraction of maxillary and mandibular molars with and without the use of local simvastatin by evaluating changes in bone density, ridge width and ridge height by comparing with sockets packed with local simvastatin. The rationale of the study is to evaluate the role of simvastatin in post extraction sockets for ridge preservation.