Skip to main content
SpringerLink
Log in

Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery.

Materials and methods

A systematic search was conducted to identify randomized controlled clinical trials (RCTs). The primary outcomes examined were post-operative pain (POP) and consumption of rescue analgesics following implant placement; secondary outcomes included adverse effects, post-operative inflammation, infection, swelling, bleeding, patient satisfaction, and quality of life. Random effects meta-analysis was conducted for risk ratios of dichotomous data.

Results

Nine RCTs fulfilled the eligibility criteria. Individual studies and meta-analysis of two studies indicated that nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced POP and consumption of rescue analgesics after dental implant placement compared to placebo. Transdermal administration of NSAIDs may be superior to the oral route as it was similarly effective for POP control and resulted in fewer side effects. Glucocorticoids administered as primary analgesics or NSAID adjuvants resulted in comparable pain sensation compared to NSAIDs alone. Caffeine-containing analgesics were reported as acceptable and effective for the treatment of POP and swelling when compared to codeine adjuvants. With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement. Risk of bias assessment indicated an overall low risk of bias across the included trials.

Conclusion

Within the limitations of this review, POP 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.

Clinical relevance

Short-term use of analgesic medications may be sufficient for post-operative pain management in dental implant surgery. Ultimately, the clinician’s analgesic prescription should be directed by a patient’s medical history, in order to increase the success of pain management in a short period of time and decrease potential adverse effects.

Trial registration

CRD42018099324

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rudd RA, Aleshire N, Zibbell JE, Gladden RM (2016) Increases in drug and opioid overdose deaths--United States, 2000-2014. MMWR Morb Mortal Wkly Rep 64(50-51):1378–1382

    Article  PubMed  Google Scholar 

  2. Moore PA et al (2018) Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J Am Dent Assoc 149(4):256–265. e3

    Article  PubMed  Google Scholar 

  3. Bryce G, Bomfim DI, Bassi GS (2014) Pre- and post-operative management of dental implant placement. Part 1: management of post-operative pain. Br Dent J 217(3):123–127

    Article  PubMed  Google Scholar 

  4. Garg A (2011) Analgesia in implant dentistry. Dent Implantol Updat 22(6):41–45

    Google Scholar 

  5. Eli I, Schwartz-Arad D, Baht R, Ben-Tuvim H (2003) Effect of anxiety on the experience of pain in implant insertion. Clin Oral Implants Res 14(1):115–118

    Article  PubMed  Google Scholar 

  6. Beaudette JR, Fritz PC, Sullivan PJ, Piccini A, Ward WE (2018) Investigation of factors that influence pain experienced and the use of pain medication following periodontal surgery. J Clin Periodontol 45(5):578–585

    Article  PubMed  PubMed Central  Google Scholar 

  7. Higgins JP et al (2019) Cochrane handbook for systematic reviews of interventions. Wiley

  8. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  9. Keerthna M, Dhanraj M, Jain ARJDIT (2018) Analgesic effectiveness of opioid agonists in post-operative pain after endosseous dental implant placement–a split-mouth randomized control trial. 10(2)

  10. Al-Khabbaz AK, Griffin TJ, Al-Shammari KF (2007) Assessment of pain associated with the surgical placement of dental implants. J Periodontol 78(2):239–246

    Article  PubMed  Google Scholar 

  11. Reddy MS, Jeffcoat MK, Richardson RC (1990) Assessment of adjunctive flurbiprofen therapy in root-form implant healing with digital subtraction radiography. J Oral Implantol 16(4):272–276

    PubMed  Google Scholar 

  12. Winnett B, Tenenbaum HC, Ganss B, Jokstad A (2016) Perioperative use of non-steroidal anti-inflammatory drugs might impair dental implant osseointegration. Clin Oral Implants Res 27(2):e1–e7

    Article  PubMed  Google Scholar 

  13. Sakka S, Hanouneh SI (2013) Investigation of the effect of ibuprofen on the healing of osseointegrated oral implants. J Investig Clin Dent 4(2):113–119

    Article  PubMed  Google Scholar 

  14. Karabuda ZC, Bolukbasi N, Aral A, Basegmez-Zeren C, Ozdemir T (2007) Comparison of analgesic and anti-inflammatory efficacy of selective and non-selective cyclooxygenase-2 inhibitors in dental implant surgery. J Periodontol 78(12):2284–2288

    Article  PubMed  Google Scholar 

  15. Gonzalez-Santana H et al (2005) Pain and inflammation in 41 patients following the placement of 131 dental implants. Med Oral Patol Oral Cir Bucal 10(3):258–263

    PubMed  Google Scholar 

  16. Li S et al (2015) Dexmedetomidine analgesia effects in patients undergoing dental implant surgery and its impact on postoperative inflammatory and oxidative stress. Oxidative Med Cell Longev 2015:186736

    Article  Google Scholar 

  17. Jeffcoat MK et al (1995) The effect of systemic flurbiprofen on bone supporting dental implants. J Am Dent Assoc 126(3):305–311 quiz 346-7

    Article  PubMed  Google Scholar 

  18. Iero PT et al (2018) A prospective, randomized, open-label study comparing an opioid-sparing postsurgical pain management protocol with and without liposomal bupivacaine for full-arch implant surgery. Int J Oral Maxillofac Implants 33(5):1155–1164

    Article  PubMed  Google Scholar 

  19. Bahammam MA, Kayal RA, Alasmari DS, Attia MS, Bahammam LA, Hassan MH, Alzoman HA, Almas K, Steffens JP (2017) Comparison between dexamethasone and ibuprofen for postoperative pain prevention and control after surgical implant placement: a double-masked, parallel-group, placebo-controlled randomized clinical trial. J Periodontol 88(1):69–77

    Article  PubMed  Google Scholar 

  20. Sanchez-Perez A et al (2018) Effects of the preoperative administration of dexketoprofen trometamol on pain and swelling after implant surgery: a randomized, double-blind controlled trial. J Oral Implantol 44(2):122–129

    Article  PubMed  Google Scholar 

  21. Bolukbasi N et al (2012) Efficacy of quick-release lornoxicam versus placebo for acute pain management after dental implant surgery: a randomised placebo-controlled triple-blind trial. Eur J Oral Implantol 5(2):165–173

    PubMed  Google Scholar 

  22. Samieirad S, Afrasiabi H, Tohidi E, Qolizade M, Shaban B, Hashemipour MA, Doaltian Shirvan I (2017) Evaluation of caffeine versus codeine for pain and swelling management after implant surgeries: a triple blind clinical trial. J Craniomaxillofac Surg 45(10):1614–1621

    Article  PubMed  Google Scholar 

  23. Pereira GM, Cota LO, Lima RP, Costa FO (2020) Effect of preemptive analgesia with ibuprofen in the control of postoperative pain in dental implant surgeries: a randomized, triple-blind controlled clinical trial. J Clin Exp Dent 12(1):e71–e78

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bhutani N, Sangolikar D, Bhutani S, Tapashetti R, Pushpalatha H (2019) Sublingual Piroxicam as Preemptive Analgesia in Single Implant Surgery. J Contemp Dent Pract 20(6):750–753

    Article  PubMed  Google Scholar 

  25. Alissa R, Sakka S, Oliver R, Horner K, Esposito M, Worthington HV, Coulthard P (2009) Influence of ibuprofen on bone healing around dental implants: a randomised double-blind placebo-controlled clinical study. Eur J Oral Implantol 2(3):185–199

    PubMed  Google Scholar 

  26. Raja Rajeswari S, Gowda T, Kumar T, Mehta DS, Arya K (2017) Analgesic efficacy and safety of transdermal and oral diclofenac in postoperative pain management following dental implant placement. Gen Dent 65(4):69–74

    PubMed  Google Scholar 

  27. Meta IF, Bermolen M, Macchi R, Aguilar J (2017) Randomized controlled trial comparing the effects of 2 analgesic drug protocols in patients who received 5 dental implants. Implant Dent 26(3):412–416

    Article  PubMed  Google Scholar 

  28. Moore RA et al (2011) Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev (9):Cd008659

  29. Moore RA et al (2014) Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain 155(1):14–21

    Article  PubMed  Google Scholar 

  30. Coutinho AE, Chapman KE (2011) The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol 335(1):2–13

    Article  PubMed  PubMed Central  Google Scholar 

  31. Steffens JP, Santos FA, Pilatti GL (2011) Postoperative periodontal pain prevention using two dexamethasone medication protocols: a double-blind, parallel-group, placebo-controlled randomized clinical trial. Am J Dent 24(6):354–356

    PubMed  Google Scholar 

  32. Krasner P, Jackson E (1986) Management of posttreatment endodontic pain with oral dexamethasone: a double-blind study. Oral Surg Oral Med Oral Pathol 62(2):187–190

    Article  PubMed  Google Scholar 

  33. Pochapski MT, Santos FA, de Andrade ED, Sydney GB (2009) Effect of pretreatment dexamethasone on postendodontic pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108(5):790–795

    Article  PubMed  Google Scholar 

  34. Aminoshariae A, Kulild JC, Donaldson M, Hersh EV (2016) Evidence-based recommendations for analgesic efficacy to treat pain of endodontic origin: a systematic review of randomized controlled trials. J Am Dent Assoc 147(10):826–839

    Article  PubMed  Google Scholar 

  35. Rashwan WA (2009) The efficacy of acetaminophen–caffeine compared to ibuprofen in the control of postoperative pain after periodontal surgery: a crossover pilot study. J Periodontol 80(6):945–952

    Article  PubMed  Google Scholar 

  36. Baratloo A et al (2016) The role of caffeine in pain management: a brief literature review. Anesthesiol Pain Med 6(3)

  37. Sollevi A (1997) Adenosine for pain control. Acta Anaesthesiol Scand 41(S110):135–136

    Article  Google Scholar 

  38. Raisian S, Fallahi HR, Badakhshan L, Zandian D (2012) A randomized double blind controlled trial comparing ibuprofen versus ibuprofen plus acetaminophen plus caffeine for pain control after impacted third molar surgery. Open J Stomatol 2(02):110–115

    Article  Google Scholar 

  39. Moore PA, Hersh EV (2013) Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc 144(8):898–908

    Article  PubMed  Google Scholar 

  40. Best AD, de Silva RK, Thomson WM, Tong DC, Cameron CM, de Silva HL (2017) Efficacy of codeine when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: a double-blinded randomized control trial. J Oral Maxillofac Surg 75(10):2063–2069

    Article  PubMed  Google Scholar 

  41. Koppen L et al (2018) Dentists’ prescribing of antibiotics and opioids to Medicare Part D beneficiaries: Medications of high impact to public health. J Am Dent Assoc

  42. Steinmetz C et al (2017) Opioid analgesic prescribing practices of dental professionals in the United States. JDR Clin Transl Res 2(3):241–248

    Article  Google Scholar 

  43. Huber MA, Terezhalmy GT (2006) The use of COX-2 inhibitors for acute dental pain: a second look. J Am Dent Assoc 137(4):480–487

    Article  PubMed  Google Scholar 

  44. Teater D (2015) Evidence for the efficacy of pain medications. National Safety Council, Washington, DC

    Google Scholar 

  45. Møiniche S, Kehlet H, Dahl JB (2002) A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 96(3):725–741

    Article  PubMed  Google Scholar 

  46. Banning M (2008) Topical diclofenac: clinical effectiveness and current uses in osteoarthritis of the knee and soft tissue injuries. Expert Opin Pharmacother 9(16):2921–2929

    Article  PubMed  Google Scholar 

  47. Gulcin Ural S, Yener O, Sahin H, Simsek T, Aydinli B, Ozgok A (2014) The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations. Pak J Med Sci 30(1):96–100

    PubMed  PubMed Central  Google Scholar 

  48. Maxwell JC (2011) The prescription drug epidemic in the United States: a perfect storm. Drug Alcohol Rev 30(3):264–270

    Article  PubMed  Google Scholar 

  49. Ricardo Buenaventura M, Adlaka MR, Sehgal MN (2008) Opioid complications and side effects. Pain Physician 11:S105–S120

    PubMed  Google Scholar 

  50. ADA, A.D.A (2018) Policy supports mandates on opioid prescribing and continuing education. Available from: https://www.ada.org/en/press-room/news-releases/2018-archives/march/american-dental-assoicaiton-announces-new-policy-to-combat-opioid-epidemic

  51. Risser A, Donovan D, Heintzman J, Page T (2009) NSAID prescribing precautions. Am Fam Physician 80(12):1371–1378

    PubMed  Google Scholar 

  52. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Juni P (2011) Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. Bmj 342:c7086

    Article  PubMed  PubMed Central  Google Scholar 

  53. Urban T, Wenzel A (2010) Discomfort experienced after immediate implant placement associated with three different regenerative techniques. Clin Oral Implants Res 21(11):1271–1277

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Mr. Richard McGowan (NYU Health Sciences Library liaison to the NYU College of Dentistry) for his assistance with the electronic database search process. We thank fellow researchers, Dr. Maha Bahammam (Bahammam 2017 group), Dr. Isaac Fernando Meta (Meta 2017 group), and Dr. Arturo Sanchez-Perez (Sanchez-Perez 2019 group), for kindly providing clarification with regards to study design and/or results.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue – BCCR 2W, New York, NY, 10010, USA

    Ismael Khouly

  2. Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA

    Rosalie Salus Braun & Sana Fatima

  3. Department of Periodontics, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA

    Michelle Ordway

  4. Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA

    Mashal Alrajhi & Bhupesh Kiran

  5. Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA

    Analia Veitz-Keenan

Authors
  1. Ismael Khouly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosalie Salus Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Ordway
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mashal Alrajhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sana Fatima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bhupesh Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Analia Veitz-Keenan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

I. Khouly and M. Ordway conceived the idea and contributed to study conception and design, acquisition of data, analysis and interpretation, and drafted and critically revised the manuscript; A. Veitz-Keenan contributed to review conception and design, analysis and interpretation, and critically revised the manuscript; R. S. Braun contributed to review analysis and interpretation and drafted and critically revised the manuscript; M. Alrajhi, S. Fatima, and B. Kiran contributed to study design, acquisition of data, and analysis. All authors gave final approval and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ismael Khouly.

Ethics declarations

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors, ethical approval is not required.

Informed consent

For this type of study, formal consent is not required.

Conflict of interest

The authors declare no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 39 kb)

ESM 2

(DOCX 17 kb)

ESM 3

(DOCX 45 kb)

ESM 4

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khouly, I., Braun, R.S., Ordway, M. et al. Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Invest 25, 2511–2536 (2021). https://doi.org/10.1007/s00784-021-03859-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-021-03859-y

Keywords

Search

Navigation