Non-steroidal anti-inflammatory drugs (NSAIDs) are effective pain relief for dental pain including procedures such as tooth extractions and dental implant placement (Dental Elf – 18th January 2017).1 NSAIDs work by inhibiting the cyclo-oxygenase (COX) enzyme, particularly COX-2 which results in the anti-inflammatory, anti-pyretic and analgesic properties.2 COX-2 and its associated mediators have been shown to induce bone formation however, as these enzymes are inhibited by NSAIDs, the authors undertook a review to determine if their use could affect bone healing and dental implant osseointegration.
Methods
The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to inform the methodology of this review. Medline and Embase were the databases searched and hand searching from reference lists of selected papers. Only randomised control trials were included. Both human and animal studies were included. Success of dental implants was defined through adapted Smith and Zarb (1989) criteria. Quality assessment was undertaken using the Cochrane risk of bias tool (RoB 2.0).
Results
- 99 articles were retrieved across the initial database search. Following removal of duplicates and implementation of the inclusion and exclusion criteria, 3 studies ( 1 human, 2 animal) were included in this review.
- The 2 animal studies included, 31 rats and 18 rabbits respectively.
- 1 study on rats used subcutaneous NSAIDs (Meloxicam) for 60 days following implant placement into the tibiae. The authors reported significantly reduced bone healing around implants which was assessed histologically.
- The study of rabbits used subcutaneous and oral (Diclofenac Sodium) NSAIDs for 1 week following dental implant placement into calvarial bone. Bone healing was assessed with micro-CT analysis and histology with no significant differences reported.
- The human study included 61 patients randomly allocated patients to the oral Ibuprofen or placebo group for 1 week post-operatively. Radiographic examination of bone levels at 3 and 6 months showed no significant differences.
- Only the human study had a low risk of bias, the other two animal studies had an uncertain risk of bias assigned.
Conclusions
The authors concluded:-
…” There is insufficient evidence to draw conclusions on the impact NSAIDs have on dental implant osseointegration and bone healing.”
Comments
This review only identified 3 small randomised studies on the impact of NSAIDs on dental implant osseointegration. The studies demonstrated marked heterogeneity in NSAID delivery, bone measurements and implant techniques. In addition, only one study was conducted in humans and two in animals using different bone sites tibiae (rats) and calvaria (rabbits) for the site of implant placement. The inclusion of animal studies and concerns regarding the generalisability of any findings to humans were also highlighted by the authors. Consequently, no quantitative analysis could be conducted. Whilst this systematic review was informative and based on physiological inquiry, no recommendations are made to clinical practice.
Links
Primary Paper
Dave M, Patel N. A systematic review to determine the impact of non-steroidal anti-inflammatory drugs on dental implant osseointegration. Oral Surg. 2019 August;13:57-66. Doi:10.1111/ors.12443
Other references
Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2013 Dec 12;(12):CD004624. doi: 10.1002/14651858.CD004624.pub2. PMID: 24338830.
Day RO, Graham GG. Non-steroidal anti-inflammatory drugs (NSAIDs). BMJ. 2013 Jun 11;346:f3195. doi: 10.1136/bmj.f3195. Erratum in: BMJ. 2013;347:f4310. PMID: 23757736.
Dental Elf – 18th January 2017
Endodontic postoperative pain: which non-steroidal anti-inflammatory drug?
