Effectiveness and Safety Profile of Short-Term NSAIDs Protocols in Dental Implantology. A Systematic Review of Clinical Evidence
DOI:
https://doi.org/10.15517/ijds.2025.65145Keywords:
Dental implants; NSAIDs; Postoperative pain; Osseointegration; Short-term analgesia.Abstract
This systematic review aimed to assess the clinical effectiveness and biological safety of short-term non-steroidal anti-inflammatory drugs (NSAIDs) in managing postoperative pain following dental implant surgery. A comprehensive literature search was conducted across eight databases through March 2023, following PRISMA guidelines. Only randomized controlled trials (RCTs) evaluating short-term (≤7 days) NSAID use in patients undergoing dental implant placement were included. Outcomes assessed included postoperative pain, swelling, need for rescue medication, patient satisfaction, adverse events, and effects on osseointegration. Risk of bias was assessed using GRADE and OCEMB tools. Ten RCTs met the inclusion criteria. NSAIDs studied included ibuprofen, naproxen, meloxicam, piroxicam, lornoxicam, dexketoprofen, and diclofenac. Most studies reported reduced postoperative pain and lower need for rescue medication with NSAIDs compared to placebo. Several trials also found higher patient satisfaction and reduced swelling. No significant adverse effects on marginal bone loss or osseointegration were observed in the short term. Risk of bias varied: three studies were low risk, four had some concerns, and three had high risk due to inadequate blinding or unclear randomization.The short-term use of NSAIDs appears to be effective in reducing postoperative pain and swelling after dental implant placement without negatively affecting osseointegration. However, heterogeneity in study design, protocols, and outcomes prevented meta-analysis. Further high-quality RCTs with standardized protocols are needed to establish clear clinical guidelines.
References
Albrektsson T., Dahl E., Enbom L., Engevall S., Engquist B., Eriksson A.R., Åstrand P. Osseointegrated oral implants. J Periodontol. 1988; 59 (5): 287-96. DOI: https://doi.org/10.1902/jop.1988.59.5.287
Koka S., Zarb G. On osseointegration: the healing adaptation principle in the context of osseosufficiency, osseoseparation, and dental implant failure. Int J Prosthodont. 2012; 25 (1): 48-2.
Berglundh T., Abrahamsson I., Lang N.P., Lindhe J. De novo alveolar bone formation adjacent to endosseous implants. Clin Oral Implants Res. 2003; 14: 251-62. DOI: https://doi.org/10.1034/j.1600-0501.2003.00972.x
Kumar V., Abbas A.K., Fausto N., Mitchell R.N. Acute and chronic inflammation. In: Robbins & Cotran Pathologic Basis of Disease. 8th ed. New York: McGraw-Hill Interamericana; 2007. p. 58-63.
Cook J.M., Deem T.L. Active participation of endothelial cells in inflammation. J Leukoc Biol. 2005; 77 (4): 487-95. DOI: https://doi.org/10.1189/jlb.0904554
Munford R.S. Severe sepsis and septic shock: the role of gram-negative bacteremia. Annu Rev Pathol. 2006; 1: 467-96. DOI: https://doi.org/10.1146/annurev.pathol.1.110304.100200
Bryce G., Bomfim D.I., Bassi G.S. Pre- and post-operative management of dental implant placement. Part 2: management of early-presenting complications. Br Dent J. 2014; 217 (4): 171-6. DOI: https://doi.org/10.1038/sj.bdj.2014.702
Chou R., Gordon D.B., de Leon-Casasola O.A., Rosenberg J.M., Bickler S., Brennan T., et al. Management of postoperative pain: a clinical practice guideline. J Pain. 2016; 17 (2): 131-57. DOI: https://doi.org/10.1016/j.jpain.2015.10.023
Katz J., Clarke H., Seltzer Z. Preventive analgesia: quo vadimus? Anesth Analg. 2011; 113 (5): 1242-53. DOI: https://doi.org/10.1213/ANE.0b013e31822c9a59
Gomes F.I., Aragão M.G., Teixeira Pinto V.P., Gondim D.V., Barroso F.C., Silva A.A., et al. Effects of nonsteroidal anti-inflammatory drugs on osseointegration: a review. J Oral Implantol. 2015; 41 (2): 219-30. DOI: https://doi.org/10.1563/AAID-JOI-D-13-00125
Moher D., Liberati A., Tetzlaff J., Altman D.G.; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6 (7): e1000097. DOI: https://doi.org/10.1371/journal.pmed.1000097
Atkins D., Best D., Briss P.A., Eccles M., Falck-Ytter Y., Flottorp S., et al. Grading quality of evidence and strength of recommendations. BMJ. 2004; 328 (7454): 1490. DOI: https://doi.org/10.1136/bmj.328.7454.1490
Howick J., Chalmers I., Glasziou P., Greenhalgh T., Heneghan C., Liberati A., et al. The 2011 Oxford CEBM Levels of Evidence (Introductory Document). Oxford Centre for Evidence-Based Medicine [Internet]. [cited 2025 Apr 1]. Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
Pozos-Guillen A., Garcia-Flores A., Esparza-Villalpando V., Garrocho-Rangel A. Intracanal irrigants for pulpectomy in primary teeth: a systematic review and meta-analysis. Int J Paediatr Dent. 2016; 26: 412-25. DOI: https://doi.org/10.1111/ipd.12228
Urrutia G., Bonfill X. Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis. Med Clin (Barc). 2010; 135: 507-11. DOI: https://doi.org/10.1016/j.medcli.2010.01.015
Bahammam M.A., Kayal R.A., Alasmari D.S., Attia M.S., Bahammam L.A., Hassan M.H., et al. Comparison between dexamethasone and ibuprofen for postoperative pain prevention and control after surgical implant placement: a randomized clinical trial. J Periodontol. 2017; 88 (1): 69-77. DOI: https://doi.org/10.1902/jop.2016.160353
Sanchez-Perez A., et al. Effects of the preoperative administration of dexketoprofen trometamol on pain and swelling after implant surgery: a randomized, double-blind controlled trial. J Oral Implantol. 2018; 44 (2): 122-9. DOI: https://doi.org/10.1563/aaid-joi-D-17-00185
Bozkurt N., Ersanli S., Basegmez C., Ozdemir T., Ozyalcin S. Efficacy of quick-release lornoxicam versus placebo for acute pain management after dental implant surgery: a randomized triple-blind trial. Eur J Oral Implantol. 2012; 5 (2): 165-73.
Pereira G.M., Cota L.O., Lima R.P., Costa F.O. Effect of preemptive analgesia with ibuprofen in the control of postoperative pain in dental implant surgeries: a randomized controlled clinical trial. J Clin Exp Dent. 2020; 12 (1): e71-8. DOI: https://doi.org/10.4317/medoral.56171
Karabuda Z.C., Bolukbasi N., Aral A., Basegmez-Zeren C., Ozdemir T. Comparison of analgesic and anti-inflammatory efficacy of selective and non-selective COX-2 inhibitors in dental implant surgery. J Periodontol. 2007; 78 (12): 2284-8. DOI: https://doi.org/10.1902/jop.2007.070192
Bhutani N., Sangolikar D., Bhutani S., Tapashetti R., Pushpalatha H. Sublingual piroxicam as preemptive analgesia in single implant surgery. J Contemp Dent Pract. 2019; 20 (6): 750-3. DOI: https://doi.org/10.5005/jp-journals-10024-2591
Meta I.F., Bermolen M., Macchi R., Aguilar J. Randomized controlled trial comparing the effects of 2 analgesic drug protocols in patients who received 5 dental implants. Implant Dent. 2017; 26 (3): 412-6. DOI: https://doi.org/10.1097/ID.0000000000000544
Alissa R., Sakka S., Oliver R., Horner K., Esposito M., Worthington H.V., et al. Influence of ibuprofen on bone healing around dental implants: a randomized double-blind placebo-controlled clinical study. Eur J Oral Implantol. 2009; 2 (3): 185-99.
Kumchai H., Taub D.I., Tomlinson R.E. Randomized, placebo-controlled pilot study of naproxen during dental implant osseointegration. Clin Exp Dent Res. 2025; 11 (1): e70065. DOI: https://doi.org/10.1002/cre2.70065
Rajeswari S.R., Gowda T., Kumar T., Mehta D.S., Arya K. Analgesic efficacy and safety of transdermal and oral diclofenac in postoperative pain management following dental implant placement. Gen Dent. 2017; 65( 4): 69-74.
Wehler C.J., Panchal N.H., Cotchery D.L. 3rd, Farooqi O.A,. Ferguson D.K., Foran D., et al. Alternatives to opioids for acute pain management after dental procedures: a Department of Veterans Affairs consensus paper. J Am Dent Assoc. 2021;1 52 (8): 641-52. DOI: https://doi.org/10.1016/j.adaj.2021.03.022
Wang M., Li Y., Li J., Fan L., Yu H. The risk of moderate-to-severe postoperative pain following the placement of dental implants. J Oral Rehabil. 2019; 46 (9): 836-44. DOI: https://doi.org/10.1111/joor.12815
Piggott T., Moja L., Huttner B., Okwen P. Raviglione M.C.B., Kredo T., et al. WHO model list of essential medicines: visions for the future. Bull World Health Organ. 2024; 102 (10). DOI: https://doi.org/10.2471/BLT.24.292359
Rainsford K.D. Anti-inflammatory drugs in the 21st century. Subcell Biochem. 2007; 42: 3-27. DOI: https://doi.org/10.1007/1-4020-5688-5_1
Geusens P., Emans P.J., de Jong J.J., van den Bergh J. NSAIDs and fracture healing. Curr Opin Rheumatol. 2013; 25 (4): 524-31. DOI: https://doi.org/10.1097/BOR.0b013e32836200b8
Kalyvas D.G., Tarenidou M. Influence of nonsteroidal anti-inflammatory drugs on osseointegration. J Oral Sci. 2008; 50 (3): 239-46. DOI: https://doi.org/10.2334/josnusd.50.239
Khouly I., Braun R.S., Ordway M., Alrajhi M., Fatima S., Kiran B., et al. Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig. 2021; 25 (5): 2511-32. DOI: https://doi.org/10.1007/s00784-021-03859-y
Melini M., Forni A., Cavallin F., Parotto M., Zanette G. Analgesics for dental implants: a systematic review. Front Pharmacol. 2021; 11: 634963. DOI: https://doi.org/10.3389/fphar.2020.634963
Sennerby L., Kälebo P., Thomsen P., Albrektsson T. Influence of indomethacin on the regeneration of cortical bone within titanium implants in rabbits. Biomaterials. 1993; 14 (2): 156-8. DOI: https://doi.org/10.1016/0142-9612(93)90231-P
Martins M.V., da Silva M.A., Medici Filho E., de Moraes L.C., Castilho J.C., da Rocha R.F. Evaluation of digital optical density of bone repair in rats medicated with ketoprofen. Braz Dent J. 2005; 16 (3): 207-12. DOI: https://doi.org/10.1590/S0103-64402005000300007
Goodman S., Ma T., Trindade M., Ikenoue T., Matsuura I., Wong N., et al. COX-2 selective NSAID decreases bone ingrowth in vivo. J Orthop Res. 2002; 20 (6): 1164-9. DOI: https://doi.org/10.1016/S0736-0266(02)00079-7
American Dental Association. Oral analgesics for acute dental pain [Internet]. 2020 [cited 2020 Nov 18]. Available from: https://www.ada.org/en/member-center/oral-health-topics/oral-analgesics-for-acute-dental-pain
Published
Issue
Section
License
Copyright (c) 2025 Mario Bueso-Ruiz, Mauricio Montero-Aguilar, Mauricio Montero-Aguilar, Vicente Esparza-Villalpando, Amaury Pozos-Guillén, Daniel Chavarría-Bolaños.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
ODOVTOS - Int. J. Dent. Sc. endorses CC BY-NC-SA
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator. If you remix, adapt, or build upon the material, you must license the modified material under identical terms. CC BY-NC-SA includes the following elements:
BY: credit must be given to the creator.
NC: Only noncommercial uses of the work are permitted.
SA: Adaptations must be shared under the same terms.
