Pre-Emptive Analgesia for Periodontal and Implant-Related Surgery: A Systematic Review and Meta-Analysis

This systematic review aimed to answer the question: In patients undergoing periodontal and peri-implant surgery, gingival augmentation, implant site development or placement, are pre-emptive analgesics effective in controlling post-operative pain compared with patients not receiving pre-emptive medications?

After comprehensive electronic and manual literature searches, randomised placebo-controlled clinical trials on adults undergoing the aforementioned surgeries were included. A meta-analysis was performed comparing pain (standardised mean difference) between pre-emptive medication and placebo at post-operative hours 1, 3, 6, 8, 24 and 72.

Two reviewers screened 1995 titles, included 18 studies in the systematic review (open flap debridement, osseous, mucogingival, unspecified periodontal surgery, implant placement; 1008 patients) and 7 studies in the meta-analysis. Non-steroidal anti-inflammatory drugs, acetaminophen and corticosteroids were prescribed 8 h to immediately pre-operatively and post-operatively until 12 h after the first dose. A clinically significant pain reduction peaked at 3 h (-0.81 [95% CI: -1.03, -0.58]; 9 study arms, n = 165 drug vs. n = 96 placebo patients) and was significant until 8 h (-0.54 [95% CI: -0.79, -0.28]; 7 study arms, n = 126 drug vs. n = 96 placebo patients), with moderate certainty of evidence (GRADE assessment).

Pre-emptive analgesia can reduce pain for up to 8 h following periodontal and implant placement surgery.