Impact of surface characteristics on the peri-implant microbiome in health and disease.

BACKGROUND: Because little is known about the impact of implant surface modifications on the peri-implant microbiome, we aimed to examine peri-implant communities in various surface types in order to better understand the impact of these surfaces on the development of peri-implantitis (PI). METHODS: One hundred and six systemically healthy individuals with anodized (AN), hydroxyapatite-coated (HA), or sandblasted acid-etched (SLA) implants that were >6 months in function were recruited and categorized into health (H) or PI. Peri-implant biofilm was analyzed using 16S rRNA gene sequencing and compared between health/disease and HA/SLA/AN using community-level and taxa-level metrics. RESULTS: Healthy implants did not demonstrate significant differences in clustering, alpha- or beta-diversity based on surface modification. AN and HA surfaces displayed significant differences between health and PI (p < 0.05); however, such a clustering was not evident with SLA (p > 0.05). AN and HA surfaces also differed in the magnitude and diversity of differences between health and PI. Six species belonging to the genera Shuttleworthia, Scardovia, and Prevotella demonstrated lower abundances in AN implants with PI, and 18 species belonging to the genera Fretibacterium, Tannerella, Treponema, and Fusobacterium were elevated, while in HA implants with PI, 20 species belonging to the genera Streptococcus, Lactobacillus, Veillonella, Rothia, and family Ruminococcaceae were depleted and Peptostreptococcaceae, Atopobiaceae, Veillonellaceae, Porphyromonadaceae, Desulfobulbaceae, and order Synergistales were enriched. CONCLUSIONS: Within the limitations of this study, we demonstrate that implant surface can differentially modify the disease-associated microbiome, suggesting that surface topography must be considered in the multi-factorial etiology of peri-implant diseases.

Ultrasonographic evaluation of edentulous crestal bone topography: A proof-of-principle retrospective study.

OBJECTIVE: Edentulous crestal bone ridge assessment, an essential task for planning of implant and bone regenerative procedures, is performed through radiographs. Ultrasonography, providing point of care and cross-sectional images without radiation, could be an adjunct for this purpose. The aim was to investigate the feasibility of ultrasound (US) in assessing bone ridge width (BRW) and crestal bone surface quality (CBSQ) compared with cone beam computed tomography (CBCT). STUDY DESIGN: Records of patients who were planned for implant placement in at least 1 healed edentulous ridge space with available CBCT and US images were included. The BRWs at 1, 2, and 3 mm from the crest were measured and compared. The CBSQ agreement evaluated using a 3-tier grading system was calculated. RESULTS: A total of 45 sites were included. The mean correlation of BRW was 0.97. The mean BRW differences ranged from 0.048 mm (95% confidence interval, -0.69 to 0.78 mm) at the 1-mm level to 0.18 mm (95% confidence interval, -0.92 to 1.3 mm) at the 3-mm level. There was a 91% agreement in CBSQ between the 2 methods. CONCLUSIONS: Preliminary data with a limited clinical sample size suggested that US is feasible in evaluating crestal BRW and surface quality assessment compared with CBCT.

Comprehensive peri-implant tissue evaluation with ultrasonography and cone-beam computed tomography: A pilot study.

OBJECTIVES: The aim of the present study was to explore the feasibility of ultrasonography (US) for clinical imaging of peri-implant tissues. MATERIAL AND METHODS: Patients with ≥1 implant, a cone-beam computed tomography (CBCT) scan, an US scan, and clinical photographs taken during the surgery were included. The crestal bone thickness (CBT) and facial bone level (FBL) were measured on both US and CBCT modalities, and direct FBL measurements were also made on clinical images. US measurements were compared with CBCT and direct readings. RESULTS: A total of eight implants from four patients were included. For FBL measurements, US and direct (r2 = 0.95) as well as US and CBCT (r2 = 0.85) were highly correlated, whereas CBCT correlated satisfactorily with the direct reading (r2 = 0.75). In one implant without facial bone, CBCT was not able to measure CBT and FBL accurately. The estimated bias for CBT readings was 0.17 ± 0.23 mm (p = .10) between US and CBCT. US blood flow imaging was successfully recorded and showed a wide dynamic range among patients with different degrees of clinical inflammation. CONCLUSION: US is a feasible method to evaluate peri-implant facial crestal bone dimensions. Additional US features, for example, functional blood flow imaging, may be useful to estimate the extent and severity of inflammation.

Incidence of retrograde peri-implantitis in sites with previous apical surgeries: A retrospective study.

BACKGROUND: Retrograde peri-implantitis (RPI) is a rapidly progressing periapical infection that forms around the implant apex. It is usually associated with sites adjacent to teeth with apical lesions; previous endodontic failures, retained root fragments, etc. This study aimed to study the incidence of RPI in sites with a history of apical surgeries. METHODS: Patients with sites treated for both apicoectomy and implant placement presenting to the University of Michigan School of Dentistry from 2001 to 2016 were screened. A total of 502 apicoectomies were performed, only 25 of these fit the predetermined eligibility criteria and were thus included in this retrospective analysis. RESULTS: Implants that were placed in sites with a previous apical surgery had a cumulative survival rate of 92%. The incidence of peri-implantitis was 8%, while the incidence of RPI was 20%. There was an increased trend for RPI in cases where the cause of extraction was persistent apical periodontitis (35.7%), but this increase didn't reach the level of statistical significance (P = 0.061). CONCLUSION: Implants placed in sites with previous apical surgery are not at an increased risk of implant failure or RPI.

Potential of Using an Implant Fixture as a Ridge Expander for Minor Ridge Augmentation: An Ex Vivo Randomized Controlled Study.

To place implants with minimal trauma is what the patient and clinician are seeking. Hence, the aim of this study was to quantify the potential of using an implant fixture as a ridge expander in an underprepared osteotomy. Thirty-eight edentulous sites in 12 human cadaver jaws with ridge widths ranging from 4 to 6 mm and with type 3 or type 4 bone density were randomly assigned into 2 groups. In the ridge expansion group (RE), each osteotomy was drilled to a width of 2.8 mm and depth of 11.5 mm. In the non-ridge expansion (NE) control group, each osteotomy was drilled to a width of to 3.4 mm and depth of 11.5 mm. A 3.7 mm × 11.5 mm tapered implant was inserted into each site. The ridge width before (RW1) and after (RW2) implant placement as well as the buccal plate thickness (BPT) post-insertion were measured and analyzed. In the RE group, the average RW1 and RW2 were 4.69 ± 0.45 mm and 5.54 ± 0.35 mm, respectively, corresponding to a statistically significant ridge expansion of 0.85 mm (P < .01). In the NE group, no ridge width gain was observed (RW1: 4.79 ± 0.40 mm, RW2: 4.88 ± 0.42 mm). Compared to NE, RE resulted in a statistically greater BPT (1.08 ± 0.28 mm after RE vs 0.71 ± 0.37 mm after NE, P < .001). Our study determined that it was physically possible to widen a ridge by an average of 0.85 mm by osteotomy underprepation in ridge with type 3 or type 4 bone density, which effectively turned the implant upon insertion into a ridge expander. The physiological consequences of this method of ridge expansion in a living person must be established before drawing further conclusions about its clinical indications or efficacy.

Ultrasonography for chairside evaluation of periodontal structures: A pilot study.

BACKGROUND: The crestal bone level and soft tissue dimension are essential for periodontal diagnosis and phenotype determination; yet, existing measurement methods have limitations. The aim of this clinical study was to evaluate the correlation and accuracy of ultrasound in measuring periodontal dimensions, compared to direct clinical and cone-beam computed tomography (CBCT) methods. METHODS: A 24-MHz ultrasound probe prototype, specifically designed for intraoral use, was employed. Periodontal soft tissue dimensions and crestal bone levels were measured at 40 teeth and 20 single missing tooth gaps from 20 patients scheduled to receive a dental implant surgery. The ultrasound images were interpreted by two calibrated examiners. Inter-rater agreement was calculated by using inter-rater correlation coefficient (ICC). Ultrasound readings were compared with direct clinical and CBCT readings by using ICC and Bland-Altman analysis. RESULTS: The following six parameters were measured: 1) interdental papilla height (tooth), 2) mid-facial soft tissue height (tooth), 3) mucosal thickness (tooth), 4) soft tissue height (edentulous ridge), 5) mucosal thickness (edentulous ridge), and 6) crestal bone level (tooth). Intra-examiner calibrations were exercised to achieve an agreement of at least 0.8. ICC between the two readers ranged from 0.482 to 0.881. ICC between ultrasound and direct readings ranged from 0.667 to 0.957. The mean difference in mucosal thickness (tooth) between the ultrasound and direct readings was -0.015 mm (95% CI: -0.655 to 0.624 mm) without statistical significance. ICC between ultrasound and CBCT ranged from 0.654 to 0.849 among the measured parameters. The mean differences between ultrasound and CBCT range from -0.213 to 0.455 mm, without statistical significance. CONCLUSION: Ultrasonic imaging can be valuable for accurate and real-time periodontal diagnosis without concerns about ionizing radiation.

Does flap opening or not influence the accuracy of semi-guided implant placement in partially edentulous sites?

OBJECTIVE: To investigate the effect of open-flap or flapless approaches on the accuracy of implant placement partially guided by tooth-supported surgical templates. MATERIALS AND METHODS: A total of 36 edentulous sites were selected from seven human cadaver heads. Following the preoperative implant planning using Blue Sky Plan, surgical guides were fabricated by an in-office desktop 3D printer. All the sites were randomly divided into two groups: flapless approach (n = 18), and open-flap approach (n = 18). After guided osteotomy preparation with subsequent freehand implant placement, digital intraoral scanning was performed to obtain post-operative implant positions. Based on the image registration, the deviations between the planned and actual implant position were measured and compared. RESULTS: Statistically significant variance differences between the two approaches were found in the global coronal (open-flap: 0.86 ± 0.23 mm; flapless: 1.3 ± 0.62 mm; P < .001), global apical (open-flap: 1.38 ± 0.37 mm; flapless: 1.9 ± 0.78 mm; P = .002), and depth (open-flap: 0.59 ± 0.34 mm; flapless 0.89 ± 0.78 mm; P < .001) deviations. The differences were not significant regarding lateral (coronal and apical) and angular deviations. CONCLUSIONS: In semi-guided implant surgery, the open-flap and flapless approaches demonstrate similar lateral and angular deviations. The open-flap group shows better depth control when manually inserting the implant.

Microscope and micro-camera assessment of Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study.

OBJECTIVE: We sought to assess the effectiveness of using a microscope and non-invasive camera for assessing sinus membrane perforations during transcrestal sinus floor elevation (TSFE). MATERIALS AND METHODS: Five fresh human cadaver heads corresponding to eight maxillary sinuses (six bilateral and two unilateral) underwent 4 TSFEs per sinus (a total of 32 single site elevations). Each elevation was randomly assigned to receive a three or six mm membrane elevation height (MEH). A microscope and micro-camera were used to assess the sinus membrane perforation. Afterwards, radiological and clinical membrane perforation assessments were performed. The statistical analysis results are expressed using the means, standard deviations, range values of the residual ridge height (RRH), residual ridge width (RRW), sinus membrane thickness (SMT) and incidence of perforation (IoP). Generalized linear methods were used to test for the correlation of RRH and MEH to the microscope and micro-camera perforation assessments and the correlation of microscope and micro-camera assessments with the post-operative CBCT and crestal liquid evaluation. RESULTS: The cumulative percentage of IoP was 40.62%, (23.07% with 3 mm MEH, and 76.92% with 6 mm MEH, p < 0.05). The perforation assessed using either the microscope or micro-camera coincided with the post-operative CBCT and crestal liquid assessment in 87.55% sites. No significant correlation was found between the microscope or micro-camera assessments with RRH or MEH. CONCLUSION: Application of a microscope and micro-camera during transcrestal sinus floor elevation may allow the detection of the integrity of the Schneiderian membrane with greater than 85% accuracy in this ex vivo model.

Maxillary Sinus and Surrounding Bone Anatomy With Cone Beam Computed Tomography After Multiple Teeth Loss: A Retrospective Multicenter Clinical Study.

PURPOSE: The aim of this multicenter study was to examine the residual alveolar bone anatomy and sinus mucosa pattern at maxillary sinus regions in multiple teeth loss. MATERIALS AND METHODS: This study was conducted with cone beam computed tomography images of 518 patients (267 females and 251 males) with multiple posterior maxillary teeth loss. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height and ridge width, posterior superior alveolar artery, and adjacent roots were evaluated. RESULTS: No (58.2%) or flat (19.3%) thickening morphology was detected at most of the SMs. Membrane thickening and mucosal-like morphology was more prevalent for male patients (P = 0.005). The mean sinus width was relatively low (3.64 ± 3.33 mm) at the 5-mm level and showed an expected increase toward upper levels. Most of the sinus spaces were dimensionally average (39.5%) or wide (44.7%), and no effect of gender was observed in terms of sinus dimensions (P > 0.05). CONCLUSION: Multiple teeth loss plays a role in creating an imaginary sinus anatomy constituted of a relatively narrow space compared with single-tooth loss cases, from 3.6-mm mean coronal width to 11.3 mm in the apical portion.

Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study with endoscopic validation.

OBJECTIVE: To endoscopically determine the incidence of Schneiderian membrane perforation during transcrestal maxillary sinus floor elevation (SFE), in relation to the bone preparation technique, amount of bone graft, membrane elevation height and different surgical steps. MATERIALS AND METHODS: Seven cadaver heads corresponding to 12 maxillary sinuses were used to perform three SFE via transcrestal approach per sinus (36 elevations). Each sinus was randomly assigned to either the Sinus Crestal Approach (SCA) drill kit technique (experimental group) or the conventional osteotome technique (control group). During all phases of the surgery, the integrity of the sinus membrane was monitored through endoscopic examination. RESULTS: A significant difference was found in the incidence of perforation (p = 0.007) and vertical elevation height (p < 0.001) between the study groups, favoring the experimental group. A safety elevation threshold of 5 mm without bone graft and implant placement was estimated. A significant correlation was observed between the residual ridge height and the incidence of perforation (p < 0.001; OR = 0.51). CONCLUSION: The SCA drill kit may demonstrate superior osteotomy preparation and membrane elevation capabilities to the osteotome technique, and significantly when a 6-mm SFE is indicated. Residual ridge height and vertical elevation height are risk determinant factors.

Accuracy of flapless immediate implant placement in anterior maxilla using computer-assisted versus freehand surgery: A cadaver study.

OBJECTIVE: To compare the accuracy of computer-guided surgery and freehand surgery on flapless immediate implant placement (IIP) in the anterior maxilla. MATERIAL AND METHODS: In this split-mouth design, 24 maxillary incisors in eight human cadaver heads were randomly divided into two groups: computer-guided surgery (n = 12) and freehand surgery (n = 12). Preoperatively, cone-beam computed tomography (CBCT) scans were acquired, and all implants were planned with a software (Blue Sky Plan3). Then, two types of surgeries were performed. To assess any differences in position, the postoperative CBCT was subsequently matched with the preoperative planning. For all the implants, the angular, global, depth, bucco-lingual, and mesio-distal deviations between the virtual and actual implant positions were measured. RESULTS: A significant lower mean angular deviation (3.11 ± 1.55°, range: 0.66-4.95, p = 0.002) and the global deviation at both coronal (0.85 ± 0.38 mm, range: 0.42-1.51, p = 0.004) and apical levels (0.93 ± 0.34 mm, range: 0.64-1.72, p < 0.001) were observed in the guided group when compared to the freehand group (6.78 ± 3.31°, range: 3.08-14.98; 1.43 ± 0.49 mm, range: 0.65-2.31, and 2.2 ± 0.79 mm, range: 1.01-4.02). However, the accuracy of these two approaches was similar for the depth (p = 0.366). In the buccal direction, the mean deviations of both groups showed a general tendency of implants to be positioned facially, occurring more in implants of the freehand group. CONCLUSION: In flapless IIP, computer-guided surgery showed superior accuracy than freehand surgery in transferring the implant position from the planning. However, even with the help of a guide, the final fixture position tends to shift toward a facial direction.

Ultrasonography for noninvasive and real-time evaluation of peri-implant tissue dimensions.

AIM: Existing methods for evaluating marginal bone loss and tissue biotype around dental implants present with many limitations. The aim of this study was to examine the accuracy of high-resolution, 3-dimensional ultrasound to measure peri-implant tissue dimensions. MATERIAL AND METHODS: A 25-MHz ultrasound probe prototype was used to scan peri-implant tissues of 17 implants from seven fresh human cadavers. Four ultrasonic measurements were made as follows: the marginal bone level/thickness, and mucosal level/thickness. The readings were statistically compared to cone beam computed tomography (CBCT) and/or open bone measurements. RESULTS: The correlations (r) between the ultrasound and direct/CBCT readings of the four parameters ranged from 0.85 to 0.98 (p < 0.0001). The mean absolute difference in the four parameters between ultrasound-direct and ultrasound-CBCT ranged from 0.033 to 0.24 mm. CONCLUSION: Encouraging evidence is shown that ultrasound can accurately measure peri-implant tissue dimensions. Following clinical trial validations, ultrasound offers potential as a valuable tool to evaluate long-term peri-implant tissue stability without concerns of ionizing radiation and image artefacts around implants.

Decision Making for Management of Periimplant Diseases.

INTRODUCTION: Nonsurgical and surgical management of periimplant mucositis and periimplantitis have shown promising results in arresting periimplant marginal bone loss (MBL) and preventing implant loss. However, management of periimplant diseases still remains unpredictable for full reconstruction of lost tissues and completely arrests disease progression. The present study proposes a decision tree that compiles both clinical and radiographic presentation of failing implants to aid in the decision making for their management. MATERIALS AND METHODS: An extensive literature review was performed using 3 electronic databases (PubMed, Ovid MEDLINE, and Cochrane Central) on the most recent treatment modalities for the management of periimplant diseases. DISCUSSION: Evidence-based treatment suggestions were primarily derived from periimplant defect morphology, presence, and severity of periimplant MBL. More evidence is required supporting soft-tissue augmentation for the treatment of periimplant diseases. CONCLUSION: Management of periimplant diseases can include lasers, mechanical instrumentation, chemical detoxification, and antimicrobial agents for nonsurgical approaches. On the other hand, removal of failing implants, resective surgery, guided bone regeneration, and soft-tissue grafting are presented as valid options for the surgical treatment of periimplantitis.

Corticotomy-Assisted Orthodontics for Canine Distalization: A Systematic Review and Meta-Analysis of Clinical Controlled Trials.

Numerous treatment modalities have been developed to expedite orthodontic treatment time, which improves patient compliance and reduces the likelihood of complications. Corticotomy-assisted orthodontia (CAO) is one procedure that was reported to be highly promising. An electronic search of PubMed and Embase in addition to a search of peer reviewed journals up to December 1st, 2016 was performed. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Quantitative assessment was performed on the articles that fell within the inclusion criteria. Eight randomized controlled trials (RCTs) were included. Weighted mean differences (WMD) of the amount of canine movement (mm) were calculated between the CAO group (test) and the conventional orthodontic group (control) at different follow-up periods. The WMD of canine movement after 2 weeks was 0.58 mm, and after 1 month was 0.83 mm. In longer follow-ups, the WMD after 2 months was 1.17 mm, and after 3 months was 1.61 mm. Results comparing the test and control groups in all time periods favored the CAO groups for complete canine retraction. No signifi cant adverse effects on the periodontium were reported at any of the treatment phases. CAO facilitates complete maxillary canine distalization up to 3 months, and can reduce the overall treatment time by 50%.

Impact of Sex, Age, and Season on Sinus Membrane Thickness.

PURPOSE: Sinus membrane thickness has been associated with the incidence of membrane perforation during the sinus elevation procedure. Understanding the sinus membrane thickness is essential for prevention of this specific surgical complication. Therefore, the aim of this retrospective study was to investigate the impact of sex, age, and season on the membrane thickness. MATERIALS AND METHODS: The charts of 144 healthy patients were included in the study. Cone beam computed tomography (CBCT) images from these patients were analyzed to determine the sinus membrane thickness in the coronal and sagittal views. Sex, age, and season were correlated with the membrane thickness. RESULTS: The mean thickness of the sinus membrane was 1.81 ± 1.66 mm (range: 0.47 to 9.49 mm). In 22.12% of the CBCT images, the sinus membrane was not visible. Membrane thickness of less than 2 mm was found in 70.8% of the cases. Age was found to be strongly correlated (P < .05) with sinus membrane thickness but not sex or season. CONCLUSION: Based on CBCT assessment, age was found to be a factor influencing sinus membrane thickness but not sex or season.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study.

BACKGROUND: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. RESULTS: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. CONCLUSION: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Non-invasive evaluation of facial crestal bone with ultrasonography.

PURPOSE: Facial crestal bone level and dimension determine function and esthetics of dentition and dental implants. We have previously demonstrated that ultrasound can identify bony and soft tissue structures in the oral cavity. The aim of this study is to evaluate the accuracy of using ultrasound to measure facial crestal bone level and thickness. MATERIALS AND METHODS: A commercially available medical ultrasound scanner, paired with a 14 MHz imaging probe was used to scan dental and periodontal tissues at the mid-facial site of each tooth on 6 fresh cadavers. The alveolar crest level in relation to the cemento-enamel junction and its thickness on ultrasound images were measured and compared to those on cone-beam computed tomography (CBCT) scans and/or direct measurements on a total of 144 teeth. RESULTS: The mean crestal bone level measured by means of ultrasound, CBCT and direct measures was 2.66 ± 0.86 mm, 2.51 ± 0.82 mm, and 2.71 ± 1.04 mm, respectively. The mean crestal bone thickness was 0.71 ± 0.44 mm and 0.74 ± 0.34 mm, measured by means of ultrasound and CBCT, respectively. The correlations of the ultrasound readings to the other two methods were between 0.78 and 0.88. The mean absolute differences in crestal bone height and thickness between ultrasound and CBCT were 0.09 mm (-1.20 to 1.00 mm, p = 0.06) and 0.03 mm (-0.48 to 0.54 mm, p = 0.03), respectively. CONCLUSION: Ultrasound was as accurate in determining alveolar bone level and its thickness as CBCT and direct measurements. Clinical trials will be required to further validate this non-ionizing and non-invasive method for determining facial crestal bone position and dimension.

The Effect of Locally Delivered Statins on Treating Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis.

BACKGROUND: Use of statins on adult patients with chronic periodontitis shows a positive effect on their periodontal status. However, effect of locally delivered statins on periodontal treatment has not yet been systematically analyzed. Hence, the present systematic review and meta-analysis aims to evaluate efficacy of statins on treating localized periodontal intrabony defects (IBDs). METHODS: An electronic search of three databases (PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature) between January 1, 1965 and March 1, 2016, and a hand search of peer-reviewed journals for relevant articles were performed. Controlled randomized clinical trials (RCTs) and prospective studies with data on comparison between adjunctive locally delivered statin use to mechanical scaling and root planing (SRP) and placebo in each group, with minimum 10 participants and follow-up period of at least 6 months, were included. RESULTS: Ten studies, eight RCTs and two prospective studies, were included. Each study included 15 to 105 patients between 25 and 55 years of age. Statistical results were recorded; weighted mean difference (WMD) and confidence interval (CI) were calculated; and meta-analyses were performed for defect fill, probing depth (PD) reduction, and clinical attachment level (CAL) gain in both statin and placebo/no treatment groups. Overall analysis of defect fill presented WMD of 1.37 mm (95% CI = 0.96 to 1.77; P <0.0001), PD reduction presented WMD of 1.76 mm (95% CI = 1.04 to 2.47; P <0.0001), and CAL gain presented WMD of 1.58 mm (95% CI = 0.89 to 2.28; P <0.0001). However, comparison presented considerable heterogeneity among studies. CONCLUSIONS: This systematic review and meta-analysis find that adjunctive use of locally delivered statins to mechanical SRP is beneficial to increasing bone fill percentage. Improved inflammatory and bleeding control as well as PD reduction and CAL gain are possible advantages to using these drugs in treating patients with periodontal IBDs.