Simvastatin: A new therapeutic material in dentistry
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Simvastatin is a new therapeutic material in the field of dentistry and still under dental research. Its structural analogs of HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) that are considered to be the first line to control hyperlipidemia and it has been recognized as a safe and low-priced drug with worldwide longtime usage. Moreover, statin has multiple functions including anti-inflammatory, antimicrobial, and induction of angiogenesis and improvement of the vascular endothelial cell function. In addition, several statin products have an anabolic effect on bone metabolism and promote bone formation through inhibition of both osteoclast activity and apoptosis of osteoblasts. And this effect appears to be related to increased expression of bone morphogenic protein-2 in osteogenic cells.

Crack sealed by dentin is considered the proper biological and mechanical management of tooth crack. Simvastatin was used in this clinical report as an intracanal medicament to seal the tooth crack because previous experimental studies proved that it can stimulate dentin formation. Painful symptoms disappeared during the rest-treatment which proved the therapeutic effects of simvastatin. The healing occurred in our study is in agreement with Madi et al, Rutledge et al, Jia et al, and Varalakshmi et al; these studies used simvastatin for bone and dentin formation.

The exact mechanism or mode of action of simvastatin in the crack seal is not known. However, the anti-inflammatory, antimicrobial, antioxidant, and wound/bone healing properties of simvastatin may explain healing and rapid relief of pain after the application of the material inside the canal.

The use of simvastatin is considered as an empirical treatment that was based on experimental studies and further clinical studies should be conducted for investigation of its side effects and mode of action before its approval to be used in endodontics.