Comparison of Oral Metronidazole and Simvastatin Gels in Treating Periodontitis: A Randomized Clinical Trial

Background: Periodontitis is an inflammatory disease of connective tissue and alveolar bone. Simvastatin (SIMV) is an antihyperlipidemic drug whereas metronidazole (MET) is a commonly used drug to treat chronic periodontitis. SIMV and MET administered sub gingivally have been shown to have bone-stimulatory and anti-inflammatory effects in patients with chronic periodontitis.Objective: To evaluate and compare the efficacy of 1% MET with 1% SIMV gel on clinical parameters and inflammatory biomarkers in patients with chronic periodontitis.Materials and Methods: This randomized clinical trial included 30 patients which were divided into 3 groups by block randomization method. Control group received only scaling and root planning (SRP). Group 1 received 1% MET gel and group 2 received 1% SIMV gel as an adjunct to SRP. Periodontal pocket depth (PPD), clinical attachment level (CAL), tooth mobility (TM), bleeding (BOP), periodontal and gingival index (PI and GI), TNF-α, PGE2, and nitric oxide (NO) levels were measured. ANOVA was used for comparing the outcomes variables between groups followed by Tuckey's test. Results: Mean PPD was reduced from 3.25 mm to 1.36 mm by 1% SIMV gel and it reduced PPD to a significant level (p<0.05) as compared to 1% MET gel. Mean CAL was reduced from 3.48 mm to 1.67 mm by 1% SIMV gel and it reduced CAL to highly significant level (p<0.001) as compared to control. TM was reduced from 1.10 mm to 0.50 mm by 1% SIMV gel (p<0.01). BOP (p<0.001), GI (p<0.001) and TNF-α (p<0.05) levels were reduced by 1% SIMV gel (p<0.001) as compared to 1% MET gel. Conclusion: Gel containing 1% SIMV is more efficacious in decreasing the clinical parameters and inflammatory biomarkers as compared to gel containing 1% MET in treating periodontitis. Keywords: Chronic periodontitis, Metronidazole, Simvastatin.