Preemptive analgesia with steroidal and non-steroidal anti-inflammatory drugs in dental implant surgeries: a systematic review

ABSTRACT Purpose: This systematic review aimed to evaluate the efficacy and safety of preemptive analgesia using oral steroidal and nonsteroidal anti-inflammatory drugs (NSAIDs) in adults undergoing dental implant surgery. Materials and Methods: A comprehensive search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Excerpta Medica Database (EMBASE), Virtual Health Library (VHL), Web of Science, and other databases with no restrictions on language or publication date. Randomized clinical trials (RCTs) comparing oral steroidal drugs or NSAIDs with placebo or other anti-inflammatory drugs were included. The primary outcomes were postoperative pain, edema, trismus, discomfort, and use of rescue medication. Pairs of reviewers independently extracted data and assessed the risk of bias. Owing to clinical heterogeneity among the included studies, a narrative synthesis was conducted. Results: Seven RCTs (n = 589 patients) evaluated aceclofenac 100 mg (in combination with acetaminophen), dexamethasone 4 mg, dexketoprofen 25 mg, etoricoxib 90 mg, ibuprofen 600 mg, ketorolac 10 mg, meloxicam 15 mg, nimesulide 100 mg, piroxicam 40 mg, and tenoxicam 20 mg. Favorable results have been reported with etoricoxib 90 mg, ibuprofen 600 mg, and nimesulide 100 mg for controlling postoperative pain and discomfort in single-implant procedures. Meloxicam and tenoxicam have demonstrated efficacy in invasive surgeries involving multiple implants and advanced techniques. Some studies have extended anti inflammatory use to the postoperative period beyond rescue medication, potentially biasing the interpretation of preemptive efficacy. To date, no adverse drug reactions have been reported. Conclusion: Owing to the heterogeneity in protocols, drug regimens, and outcome measures, definitive conclusions regarding the most effective and safest preemptive agents could not be drawn. Future trials should emphasize methodological standardization and focus on widely used drugs to support evidence-based decisions in implant dentistry.