Khouly Ismael, Braun Rosalie Salus, Ordway Michelle, Alrajhi Mashal, Fatima Sana, Kiran Bhupesh, Veitz-Keenan Analia
Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue - BCCR 2W, New York, NY, 10010, USA.
Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA.
Clin Oral Investig. 2021 May;25(5):2511-2536. doi: 10.1007/s00784-021-03859-y. Epub 2021 Apr 10.
To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery.
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.
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.
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.
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.
CRD42018099324.
评估各种止痛药物在减轻牙种植术后口面部疼痛方面的临床疗效。
进行系统检索以识别随机对照临床试验（RCT）。所检查的主要结局为术后疼痛（POP）以及种植体植入后急救镇痛药的使用情况；次要结局包括不良反应、术后炎症、感染、肿胀、出血、患者满意度和生活质量。对二分数据的风险比进行随机效应荟萃分析。
9项RCT符合纳入标准。个别研究以及两项研究的荟萃分析表明，与安慰剂相比，非甾体抗炎药（NSAIDs）在牙种植体植入后能显著减轻POP并减少急救镇痛药的使用。NSAIDs经皮给药可能优于口服途径，因为它在控制POP方面同样有效且副作用更少。作为主要镇痛药或NSAIDs佐剂使用的糖皮质激素与单独使用NSAIDs相比，产生的疼痛感觉相当。与可待因佐剂相比，含咖啡因的镇痛药在治疗POP和肿胀方面被认为是可接受且有效的。关于镇痛给药方案，在牙种植体植入后的最初72小时内，疼痛调节可能最为关键。偏倚风险评估表明，纳入的试验总体偏倚风险较低。
在本综述的局限性范围内，种植术后的POP可通过短期使用止痛药物有效治疗。然而，鉴于现有RCT的异质性，尚无足够证据推荐牙种植术后的镇痛方案。
短期使用止痛药物可能足以用于牙种植手术的术后疼痛管理。最终，临床医生的镇痛处方应根据患者的病史来确定，以便在短时间内提高疼痛管理的成功率并减少潜在的不良反应。
CRD42018099324。
