ABSTRACT
PURPOSE: Dental implant placement is often followed by acute pain, which is one of the most important patient-centered matters of treatment. However, this pain is often not adequately appreciated by clinicians, and knowledge about risk factors associated with acute pain is scant. An understanding of these factors is important to help clinicians deliver efficient pain control advice based on individual demand. MATERIALS AND METHODS: A systematic review of the literature was carried out to identify published risk factors for acute pain after dental implant surgery. PubMed, Cochrane Central Register of Controlled Trials, Embase, and Google Scholar databases were searched to find pertinent studies up to August 2019. Cohorts and randomized controlled trials (RCTs; including split-mouth trials) were included. The criteria used were those described in the PRISMA statement for performing systematic reviews. RESULTS: Nine hundred twenty-five papers were identified through the initial searching. After three stages of screening, 38 articles were included in the qualitative analysis but only 8 in the quantitative analysis. Despite the heterogeneity of the included articles, these data showed that flapped (vs flapless) surgery, anxiety, longer surgical duration, anticipation of more pain before surgery, and higher pain levels at earlier time points play a key role in the intensity of acute pain after dental implant surgery. There is strong evidence to suggest that the place of insertion (maxilla/mandible) is not a risk factor for pain. CONCLUSION: The results for the effect of immediate loading (vs delayed loading), number of implants inserted, sex, age, and smoking on pain were inconclusive.
Subject(s)
Acute Pain , Dental Implants , Acute Pain/etiology , Dental Implantation, Endosseous/adverse effects , Dental Implants/adverse effects , Humans , Surgical FlapsABSTRACT
BACKGROUND: The purpose of this study was to perform a histological, histomorphometrical, and immunohistochemical evaluation of the effect of Enamel matrix derivative (EMD) on bone formation around titanium dental implant. MATERIALS AND METHODS: In this animal study, 12 implants (10 × 3.8 mm) were inserted in the tibia bone of three dogs of Iranian breed. Two implants were placed in each tibia with EMD only on the left side. The dogs were sacrificed 2, 4, and 6 weeks after implantation. Following decalcification of the implants' surrounding tissue and preparation of 4 µm thick sections, they were stained with hematoxylin and eosin (H and E) and immunohistochemical (IHC) stain for osteopontin (OPN) marker. Histomorphometric evaluation was performed via measurement of the percentage of the woven, lamellar, and total generated bone. Light microscopy osteoblastic intensity of OPN in osteoblasts and bone matrix was also evaluated Data were analyzed by Wilcoxon signed Ranks, and Mc Nemar tests. RESULTS: In both control and EMD-applied groups, bone formation was recognized around the implants at the 4(th) week postimplantation. The percentage of total generated bone in the test group was higher than the control group, although being not statistically significant (P value = 0.917). Osteoclasts exhibited significantly higher proliferation activity compared the control group when stimulated by EMD (P value = 0.027). On average, the staining intensity in osteoblasts and extracellular matrix of bone, in EMD-applied subjects was higher than those of the controls (P value = 0.167 and P value = 0.414, respectively). CONCLUSION: EMD enhanced bone formation around dental implants, but this increase was not significant.
