Local Simvastatin for Hard-Tissue Healing After Third Molar Extraction: A Systematic Review.

BACKGROUND

After third molar extraction, the socket undergoes a physiological healing and remodeling process that influences postextraction bone fill. Because third molar surgery provides a relatively standardized clinical model for evaluating socket healing, several local adjuncts have been investigated to enhance osteogenesis and improve hard-tissue repair. Among these, simvastatin has attracted interest because of its reported osteopromotive, angiogenic, and antiresorptive effects. However, the available clinical evidence remains heterogeneous. The aim of this systematic review was to evaluate the effects of locally delivered simvastatin on hard-tissue healing and postoperative clinical outcomes in third molar extraction sockets.

METHODS

PubMed, Scopus, Web of Science, and LILACS were searched from inception to October 10, 2025. Clinical studies assessing local/topical simvastatin in mandibular or maxillary third molar sockets were included. Primary outcomes were postextraction hard-tissue healing and bone regeneration assessed by radiographic, tomographic, histologic, or histomorphometric parameters. Secondary outcomes included pain, swelling, trismus, soft-tissue healing, and postoperative complications. Because of marked heterogeneity, findings were synthesized narrative.

RESULTS

Ten studies were included. Most reported improved radiographic or tomographic indicators of hard-tissue healing in simvastatin-treated sockets, including higher gray-scale values, greater bone density, earlier mineralization, and improved trabecular microarchitecture. Clinical outcomes were less consistent, with variable effects on pain, swelling, and soft-tissue healing. Comparative studies showed mixed results.

CONCLUSIONS

Local simvastatin may be associated with improved imaging-based indicators of hard-tissue healing after third molar extraction, but the evidence remains heterogeneous, methodologically limited, and less consistent for patient-centered outcomes.