Avoiding Breakthrough Pain Following Dental Implant Surgery

Because dental implant post-surgical pain is mainly driven by inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (eg, Advil\'ae, Motrin\'ae IB) or naproxen sodium (Aleve\'ae) are logical choices to address it. These drugs are highly efficacious, non-addicting, and generally well tolerated. Dental implant patients, however, are generally older than those having their impacted third molars removed and are, therefore, likely to present with more comorbidities and drug intake, leading to potentially more adverse effects and serious adverse drug interactions. Fortunately, pain following dental implant surgery is generally milder than that of impacted third molar surgery and is amenable to low over-the-counter (OTC) dosing regimens. Administering NSAIDs immediately after surgery before the local anesthesia has worn off and then around the clock for 2 to 3 days appears to be an effective strategy at not only preventing the onset of postoperative pain, but also diminishing breakthrough pain, which is typically seen with as-needed (PRN) dosing. Implant surgeons must be able to identify those patients in whom a short course of NSAIDs can be used safely and employ dosing strategies that provide optimal analgesic efficacy while limiting untoward events. This article discusses current recommendations for postoperative pain management in dental implant patients, emphasizing the role of NSAIDs while addressing patient-specific safety considerations.