Adly Mahmoud Sedky, Adly Afnan Sedky, Alreshidi Sanad Faleh, Alotaibi Abdulaziz Mohsen, Alreshidi Meshari Faleh, Adly Aya Sedky
Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
Royal College of Surgeons of Edinburgh, Scotland, United Kingdom.
J Dent Sci. 2021 Jan;16(1):137-144. doi: 10.1016/j.jds.2020.05.026. Epub 2020 Jul 4.
BACKGROUND/PURPOSE: Dental implants insertion can be a major factor in stress and anxiety. The aim was to evaluate the paracetamol ability to lower stress and anxiety when compared with ibuprofen during and after computer guided implant surgery utilizing CAD/CAM surgical template and a computer vision system for assessment.
Thirty patients were enrolled in a crossover study design having bilateral missing lower molars. Patients were randomized into 2 equal groups with the first assigned for dental implant insertion in the lower molar area on one side with the administration of paracetamol (with 7-day follow-up) followed by 2-week washout period, then another implant was inserted on the contra-lateral side with ibuprofen. The second group received the same drugs but in reversed order. Salivary cortisol level was used to measure anxiety and a computer vision system was used to measure swelling. Visual-Analogue-Scale pain score from 0-to-100 was also utilized.
Only 29 patients completed the study. Stress and anxiety was found to be significantly lower in paracetamol group (4.1 ± 1.08 ng/mL and 6.2 ± 0.94 ng/mL for paracetamol/ibuprofen respectively). Pain score was 13.1 ± 1.1 and 12.9 ± 2.3 in paracetamol/ibuprofen groups respectively with no significant differences. Swelling showed significant difference favoring the paracetamol group (0.91 ± 0.41 and 0.61 ± 0.31 for paracetamol/ibuprofen respectively).
Paracetamol is effective in reducing stress by minimizing anxiety and blunting emotions of "fear-from-pain" so that pain is no longer perceived as much. However, paracetamol lacks the ability to control swelling at implant site. Computer guided flapless-implant surgery with immediate loading can be recommended for fearful patients.
背景/目的:植入牙种植体可能是导致压力和焦虑的一个主要因素。本研究旨在评估在使用CAD/CAM手术模板和计算机视觉系统进行计算机引导种植手术期间及术后,与布洛芬相比,对乙酰氨基酚降低压力和焦虑的能力。
30例双侧下颌磨牙缺失的患者参与了一项交叉研究设计。患者被随机分为两组,每组人数相等,第一组在一侧下颌磨牙区植入牙种植体并服用对乙酰氨基酚(随访7天),随后有2周的洗脱期,然后在对侧植入另一枚种植体并服用布洛芬。第二组接受相同药物,但顺序相反。唾液皮质醇水平用于测量焦虑,计算机视觉系统用于测量肿胀。还采用了0至100的视觉模拟疼痛评分。
只有29例患者完成了研究。发现对乙酰氨基酚组的压力和焦虑明显更低(对乙酰氨基酚/布洛芬组的唾液皮质醇水平分别为4.1±1.08 ng/mL和6.2±0.94 ng/mL)。对乙酰氨基酚/布洛芬组的疼痛评分分别为13.1±1.1和12.9±2.3,无显著差异。肿胀显示对乙酰氨基酚组有显著差异(对乙酰氨基酚/布洛芬组分别为0.91±0.41和0.61±0.31)。
对乙酰氨基酚通过最大限度地减少焦虑和减弱“疼痛恐惧”情绪来有效减轻压力,从而使疼痛不再被过多感知。然而,对乙酰氨基酚缺乏控制种植体部位肿胀的能力。对于有恐惧心理的患者,可推荐采用计算机引导的无瓣种植手术并即刻加载。