The placement of dental implants is now a very common surgical procedure and appropriate management of any post-operative pain is an important element of patient care. Nonsteroidal anti- inflammatory drugs (NSAIDs), with or without acetaminophen have been shown to be equally effective or better than opioid medications for post-operative dental pain relief ( Moore et al.2018).
The aim of this review was to evaluate the clinical efficacy of analgesics in mitigating orofacial pain following dental implant surgery.
The review protocol was registered on the PROSPERO database. searches conducted in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Dentistry & Oral Sciences Source (DOSS), clinicaltrials.gov, www.centerwatch.com/clinicaltrials and www. clinicalconnection.com databases supplemented by handsearching in dental journals. Randomised controlled trials (RCTs) involving 10 or more patients with a minimum of 12 hours follow up were considered. The primary outcomes were patient reported pain and need for rescue analgesics. Initially 3 reviewers independently selected studies with final selection by two independent reviewers. Two reviewers independently extracted data with 3 reviewers assessing risk of bias using the Cochrane domains-based tool. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI) and continuous outcomes as mean differences (MD) with 95%CI.
- 9 RCTs involving a total of 560 patients (829 implants) were included.
- All 9 studies were considered to have a low risk of bias.
- 8 studies involved use of non-steroidal anti-inflammatory drugs (NSAIDS) with 2 studies also involving the use of corticosteroids.
- 1 study involved opioid versus caffeine adjuvants
- A wide range of medications were used, Ibuprofen, Lornoxicam, Dexketoprofen trometamol, Piroxicam, Ketorolac, Ketorolac and betamethasone, Dexamethasone, Acetaminophen with codeine and Acetaminophen with caffeine.
- 5 RCTs concluded that NSAIDS pre- or post-operatively significantly reduced pain.
- Of 5 studies reported adverse effects, one reported gastric side effects in the ibuprofen and 4 reported no side effects
- One study comparing the transdermal and oral NSAID administration reported that 3 patients taking the oral NSAID had gastric side effects but there were no adverse effects in patients using the transdermal patch.
The authors concluded: –
….post-operative pain following implant surgery may be effectively treated with the short-term use of analgesic medications. However, given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery.
This review has a pre-registered protocol on the PROSPERO database and has followed a standard systematic review methodological approach. A broad range of databases have been searched and this has been supplemented with hand searching in a range of journals. A total of 9 RCTs met the inclusion criteria with a broad range of NSAIDs being investigated. Few of the NSAIDS were tested in more than one study so a detailed narrative summary and table of the individual studies are presented in the paper.
Five of the 9 included studies found significantly reduced post-operative pain with the use of NSAIDS however the number of available studies is small, and the lack of comparative studies means that the most effective medication cannot be determined. Only 5 of the included studies reported on adverse effects which should be reported in future studies in this area. Some concerns relating to the NSAID use and osteointegration have also been raised (Dental Elf – 20th Nov 2020). In addition, additional information is required on which medication, dosage, dosing schedule, and administration route as highlighted by the authors.
Khouly I, Braun RS, Ordway M, Alrajhi M, Fatima S, Kiran B, Veitz-Keenan A. Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig. 2021 May;25(5):2511-2536. doi: 10.1007/s00784-021-03859-y. Epub 2021 Apr 10. PMID: 33839939.
Moore PA, Ziegler KM, Lipman RD, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. J Am Dent Assoc. 2018 Apr;149(4):256-265.e3. doi: 10.1016/j.adaj.2018.02.012. Erratum in: J Am Dent Assoc. 2018 Jun;149(6):413. Erratum in: J Am Dent Assoc. 2020 Mar;151(3):163. PMID: 29599019.
Dental Elf – 7th Jun 2017
Dental Elf – 20th Nov 2020