Date of Award
Spring 2024
Document Type
Thesis
Degree Name
Master of Science (MS)
Department
Dentistry
First Advisor
Vrisiis Kofina
Abstract
Objective: The purpose of this systematic review and meta-analysis is to document the effect of preemptive analgesia on patient-reported pain following periodontal and implant-related surgical procedures. Methods: A comprehensive search of the literature was conducted in PubMed, Cochrane, and Web of Science (PROSPERO ID: CRD42023471166). Randomized placebo-controlled clinical trials on adults undergoing periodontal and implant-related surgeries were included. A meta-analysis was performed comparing pain data at postoperative hours 1, 3, 6, 8, 24 and 72 between pre-emptive medication versus placebo groups. Results: Two independent reviewers screened 1,044 titles and included 15 studies (open flap debridement 6/12; flap and osseous surgery 1/15; unspecified periodontal surgery 5/15; implant placement 3/15) in the systematic review and 8 studies in the quantitative synthesis and meta-analysis. There were no studies on soft tissue augmentation, extraction and alveolar ridge preservation or augmentation, sinus or bone augmentation at edentulous sites. Non-steroidal anti-inflammatory drugs (ibuprofen 400mg/600mg/800mg, diflunisal 100mg/500mg, ketorolac 10mg, etoricoxib 120mg, celecoxib 200mg, nimesulide 100mg) and corticosteroids (dexamethasone 4mg/8mg) were prescribed 8 hours to immediately pre-operatively, and immediately postoperatively until 12 hours. Random and fixed effects forest plots revealed a difference in pain between preemptive analgesia and placebo groups at postoperative hour 1 (-0.70 [95% CI: -1.26,-0.15]) with the most significant difference at hour 3 (-0.81 [95% CI: -1.03, - 0.58]). The mean difference remained significant at hours 6 and 8 (-0.66 [95% CI: -0.85, -0.48]; -0.54 [95% CI: -0.79, -0.28] respectively) and became not significant at 24 hours (-0.41 [95% CI: -1.17, 0.34]). The highest heterogeneity was observed at hour 1 (χ210=48.08 [p<0.001], I2=79%). Conclusion: Preemptive analgesic drug administration can reduce pain up to 8 hours following periodontal surgery. Keywords: Systematic review; meta-analysis; preemptive analgesia; pain; periodontal surgery; dental implant