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

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.

Reconstructing Peri-implant and Papillary Soft Tissue in the Esthetic Area Using Interdental Tissue, a Tuberosity Connective Tissue Graft, and a Tunneling Approach: A Case Report.

Long-term survival of dental implants in both fully and partially edentulous patients has been proven successful, as reported in the literature. However, maintenance of soft-tissue quality and volume is often difficult due to the multiple surgeries involved in implant placement and the physiological resorption of bone after tooth extraction. Soft-tissue augmentation is frequently necessary to improve soft-tissue contour and can be done simultaneously with implant or abutment placement or following the final insertion of the implant-supported prostheses. The purpose of this case report is to demonstrate a surgical procedure used to augment a peri-implant buccal soft-tissue defect using interdental palatal tissue from a pocket reduction procedure in combination with a distal wedge graft from the tuberosity as connective tissue utilizing a tunneling approach in the esthetic area. The implant restorations in the reported case were delivered 1 year prior to the soft-tissue reconstruction.