ABSTRACT
Introduction:
A variation in dental pain following tooth extraction and implant placement has been observed. The present study aimed to compare pain in patients undergoing tooth extraction and implant placement.
Materials and Methods:
Eighty-four patients underwent tooth extraction and implant placement in maxillary central incisor. Pain (VAS) was recorded at 24 h, 24 h, and 48 h.
Results:
The mean pain value (VAS) at 24 h post-operatively after tooth extraction was 6.1 and after implant insertion was 2.9. At 48 h after tooth extraction was 4.3 and after implant insertion was 1.1 and after 72 h after tooth extraction was 2.4 and after implant insertion was 0.27. A significant difference was observed between both procedures at different intervals of time (P < 0.05).
Conclusion:
The pain experienced by patients during dental implant insertion was comparatively less as compared to dental tooth extraction.
KEYWORDS: Dental implant, Fear, Pain
INTRODUCTION
Dental implant is the biggest achievement in the twenty-first century in the field of dentistry. Since its invention, the main aim is to make it favorable for patients. Advancements in the design of dental implant over the period of time are found to be beneficial for patients.[1]
Fear about dental procedures ranks fourth among patients. The fear is more in those who has no past history of dental treatment.[2] The administration of injection, extraction, and swelling following treatment makes patients worried and fearful. Dental pain is considered the most severe pain of all. Pain perseverance varies person to person. The past eventful extractions or any other dental treatment plays an important role to make patients ready for dental implant surgery. Dental anxiety and fear start from childhood, and if it is not managed in favorable manner, it lasts longer in adulthood also.[3]
Pain associated with dental implant insertion is of low intensity, and it reduces slowly in few days. The best management is to discuss the process with patients to make them aware and gain their confidence. Pain of dental tooth extraction is different from pain occurring in dental implant placement.[4] Therefore, the objective of this study is to compare pain experience in patients undergoing both tooth extraction and dental implant insertion.
MATERIALS AND METHODS
In this prospective, observational study, we selected 84 adult patients of age ranged 18–48 years of either gender. Inclusion criteria comprised patients within specified age group, patients undergoing maxillary central incisor tooth extraction of either side and subsequently dental implant insertion, and those willingly giving written consent. Those who did not give written consent, pregnant women and those requiring bone advancement following extraction were excluded.
Demographic characteristics of patient (age, gender, name, etc.) were entered in case sheet. After carefully evaluating oral cavity, local anesthesia was administered (2% xylocaine with 1:150000 adrenaline). Infra-orbital and nasopalatine block were given. After successful block, patient maxillary central incisor was extracted following all aseptic sterilization procedures.
In the second step, crestal incision with short releasing incisions, MISS dental implant was inserted (length breadth, 12 mm × 3.5 mm). Suturing was performed with 4–0 vicryl sutures. For the assessment of pain, visual analog scale (VAS) was used. Pain assessment was done post-operatively at 24 h, 48 h, and 72 h. All steps were performed by same expert oral surgeon. Patients were recommended Cap Penicillin 500 mg thrice daily, tab Diclofenac sodium 50 mg twice daily for 5 days. They were advised to do warm saline rinses after 24 h. All values were recorded and complied which were subjected to statistical evaluation using Chi-square test with SPSS version 21.0. Significance level was at 0.05.
RESULTS
Table 1 shows that out of 84 patients, males and females were 40 (47.7%) and 44 (52.3%), respectively.
Table 1.
Sex wise distribution of patients
| Total - 84 | ||
|---|---|---|
|
| ||
| Gender | Male | Female |
| Number (%) | 40 (47.7%) | 44 (52.3%) |
Table 2 shows that age group 18–28 years comprised 24 (60%) males and 22 (50%), 28–38 years ten (25%) males and 12 (27.2%) females, and 38–48 years six (15%) males and ten (22.8%) females. A non-significant difference was observed (P > 0.05).
Table 2.
Age wise distribution of patients
| Age group (years) | Male | Female | P |
|---|---|---|---|
| 18–28 | 24 (60%) | 22 (50%) | 0.85 |
| 28–38 | 10 (25%) | 12 (27.2%) | 0.90 |
| 38–48 | 6 (15%) | 10 (22.8%) | 0.07 |
Table 3 and Figure 1 show that mean pain value (VAS) at 24 h post-operatively after tooth extraction was 6.1 and after implant insertion was 2.9. At 48 h after tooth extraction was 4.3 and after implant insertion was 1.1 and after 72 h after tooth extraction was 2.4 and after implant insertion was 0.27. A significant difference was observed between both procedures at different intervals of time (P < 0.05).
Table 3.
Assessment of pain (VAS)
| Duration | Dental extraction | Implant insertion | P |
|---|---|---|---|
| 24 h | 6.1 | 2.9 | 0.01 |
| 48 h | 4.3 | 1.1 | 0.02 |
| 72 h | 2.4 | 0.27 | 0.01 |
Figure 1.
Assessment of pain (VAS)
DISCUSSION
Fear and pain of tooth extraction are of paramount importance in those who are willing to undergo dental implant surgery. Patients with previous dental treatment experience tend to have low pain as compared to those undergoing dental procedure first time. Dental fear is a complex of environmental, psychological, and behavioral factors. There has been direct influence of anxiety on pain perception. Thereby, fearful and anxious patients have more pain perception.[5] In this study, we compared pain perception for two different dental procedures such as dental tooth extraction and dental implant insertion in same patient.
We found that out of 84 patients, males and females were 40 (47.7%) and 44 (52.3%), respectively. Tabrizi et al.[6] conducted a study on 40 patients scheduled for dental tooth extraction and dental implant insertion. There was significant difference in pain value observed at 12 h, 24 h, 48 h, and 72 h. Patients experienced lesser pain during dental implant insertion as compared to dental tooth extraction (P < 0.05).
We observed that age group 18–28 years comprised 24 (60%) males and 22 (50%), 28–38 years ten (25%) males and 12 (27.2%) females, and 38–48 years six (15%) males and ten (22.8%) females. Al-Khabbaz et al.[7] in their study on two hundred and thirty-four patients who got five hundred and ten dental implants experienced mild and lesser pain. The pain intensity gradually decreased within 12 weeks.
We found that mean pain value (VAS) at 24 h post-operatively after tooth extraction was 6.1 and after implant insertion was 2.9. At 48 h after tooth extraction was 4.3 and after implant insertion was 1.1 and after 72 h after tooth extraction was 2.4 and after implant insertion was 0.27. Al-Khateeb et al.[8] in their study observed that 38.6% patients had mild pain. The mean pain intensity score and previous dental injection pain showed a significant correlation. Abolfazli et al.[9] observed higher pain in patients who underwent posterior teeth extraction in comparison with dental implant insertion recorded at 6 h and 1, 3, and 7 days, respectively.
Kim et al.[10] in their study on 89 patients using dental anxiety scale assessed pain value using VAS in patients undergoing dental implant placement pre-operatively, after implant placement, after 1 day and after 1 week. Females exhibited higher pain score as compared to males 1 day after surgery as compared to immediately and after 1 week. Patients who received multiple implants had higher pain score immediately after surgery.
The shortcoming of our study is limited sample size. In our study, pain perception was not compared between males and females. Patients receiving multiple implants were also not evaluated.
CONCLUSION
Our study revealed that the pain experienced by patients during dental implant insertion was comparatively less as compared to dental tooth extraction.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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