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

OBJECTIVE: 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? MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: Pre-emptive analgesia can reduce pain for up to 8 h following periodontal and implant placement surgery.