Theken Katherine N, Chen Mengxiang, Wall D Lucas, Pham Truongan, Secreto Stacey A, Yoo Thomas H, Rascon Allison N, Chang Yu-Cheng, Korostoff Jonathan M, Mitchell Claire H, Hersh Elliot V
Department of Oral and Maxillofacial Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Front Pharmacol. 2023 May 17;14:1199580. doi: 10.3389/fphar.2023.1199580. eCollection 2023.
Post-surgical pain following dental implant placement surgery is typically managed with non-opioid analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. However, the comparative analgesic efficacy of over-the-counter doses of non-steroidal anti-inflammatory drugs and acetaminophen in implant patients is unknown. Therefore, we compared the analgesic and anti-inflammatory effects of naproxen sodium and acetaminophen after surgical placement of one or two dental implants. Adult patients were treated with naproxen sodium (440 mg loading dose +220 mg q8h, = 15) or acetaminophen (1,000 mg q6h-max daily dose 3,000 mg, = 15) for 3 days after implant placement in a randomized, double-blind design. Pain was assessed on a 0-10 scale every 20 min for 6 h after study medication treatment. Tramadol (50 mg) was available as a rescue medication. Plasma and gingival crevicular fluid (GCF) were collected prior to the surgery and 0, 1, 2, 4, 6, 24, and 72 h after surgery for quantification of interleukin (IL)-6, IL-8, and IL-1β levels. Pain scores were significantly lower in patients treated with naproxen sodium compared to those treated with acetaminophen. Inflammatory mediator levels in plasma and gingival crevicular fluid increased after surgery and returned to near baseline levels by 72 h. Plasma IL-6 levels were significantly lower 6 h after surgery in patients treated with naproxen sodium compared to acetaminophen. No differences in inflammatory mediator concentrations in gingival crevicular fluid were observed between the treatment groups. The number of implants placed and body mass index (BMI) influenced inflammatory mediator concentrations in plasma and gingival crevicular fluid, respectively. Naproxen sodium was more effective than acetaminophen in reducing post-operative pain and systemic inflammation following surgical placement of one or two dental implants. Further studies are needed to determine whether these findings are applicable to more complex implant cases and how they affect clinical outcomes following implant placement. ClinicalTrials.gov, identifier NCT04694300.
牙种植体植入手术后的疼痛通常使用非阿片类镇痛药进行管理，包括非甾体抗炎药（NSAIDs）和对乙酰氨基酚。然而，非处方剂量的非甾体抗炎药和对乙酰氨基酚在种植患者中的相对镇痛效果尚不清楚。因此，我们比较了萘普生钠和对乙酰氨基酚在植入一枚或两枚牙种植体手术后的镇痛和抗炎作用。成年患者在植入种植体后采用随机双盲设计，接受萘普生钠（440mg负荷剂量+220mg每8小时一次，n = 15）或对乙酰氨基酚（1000mg每6小时一次 - 最大日剂量3000mg，n = 15）治疗3天。在研究药物治疗后6小时内，每20分钟以0 - 10分制评估疼痛程度。曲马多（50mg）作为急救药物备用。在手术前以及手术后0、1、2、4、6、24和72小时采集血浆和龈沟液（GCF），用于定量白细胞介素（IL）-6、IL-8和IL-1β水平。与接受对乙酰氨基酚治疗的患者相比，接受萘普生钠治疗的患者疼痛评分显著更低。手术后血浆和龈沟液中的炎症介质水平升高，并在72小时时恢复至接近基线水平。与对乙酰氨基酚治疗的患者相比，接受萘普生钠治疗的患者在手术后6小时血浆IL-6水平显著更低。在治疗组之间未观察到龈沟液中炎症介质浓度存在差异。植入种植体的数量和体重指数（BMI）分别影响血浆和龈沟液中炎症介质的浓度。在植入一枚或两枚牙种植体手术后，萘普生钠在减轻术后疼痛和全身炎症方面比对乙酰氨基酚更有效。需要进一步研究以确定这些发现是否适用于更复杂的种植病例，以及它们如何影响种植体植入后的临床结果。ClinicalTrials.gov标识符：NCT04694300。
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