ABSTRACT
Objective
Guided bone regeneration (GBR) is the most frequently used method for bone augmentation during dental implant surgery. This study was meant to explore the effect of simultaneous GBR on postoperative pain after dental implant surgery.
Material and Methods
This prospective cohort study included 72 patients who were divided into the following two groups based on whether GBR was performed: Group A (single dental implant placement) and Group B (single dental implant placement with GBR simultaneously). Before the surgery, patients' anxiety status and pain sensitivity were assessed via the State–trait anxiety inventory (STAI) and pain sensitivity questionnaire (PSQ), respectively. The pain values at 2 h, 4 h, 6 h, 24 h, 48 h and 72 h post‐operation were recorded using a numerical rating scale. The independent samples t‐test was performed to evaluate the difference, and p‐values < 0.05 were considered statistically significant.
Results
A total of 60 patients completed follow‐up, with 30 patients remaining in each group. Patients in Group B experienced moderate pain after the implant surgery, with the peak of pain occurring at 4 h post‐operation. And the average pain score in Group B was 4.77, which was higher than that in Group A (2.93). Furthermore, the difference in pain scores between the two groups at 4, 6 and 24 h after surgery was statistically significant (p = 0.002, 0.001 and 0.003, 95% CI = [−2.98, −0.69], [−2.40, −0.67] and [−1.05, −0.22], respectively).
Conclusion
Patients undergoing simultaneous GBR during dental implant surgery tend to experience more postoperative pain, reaching up to or exceeding a moderate level. Therefore, we suggest to pay more attention on pain management after dental implant surgery with GBR to improve postoperative comfort.
Trial Registration
ChiCTR2000041136, https://www.chictr.org.cn/)
Keywords: dental implant, GBR, pain
Simultaneous guided bone regeneration increases early postoperative pain after dental implant surgery.
1. Introduction
With the development of dental implant restoration, guided bone regeneration (GBR) has wide application in patients with bone deficiency. However, anxiety and fear associated with the pain of surgery have deterred many patients from seeking implant restorations. Research indicates that patients' main concern when visiting the dentist is the pain experience during the procedure and in the postoperative period [1] Pain is a key factor in how patients assess a dentist's skill and the success of treatment. Thus, it is essential to study the postoperative pain after dental implant surgery and GBR.
However, limited research had been conducted on the effect of GBR on postoperative pain. Mei et al. showed that complex surgeries (including bone augmentation) could cause significantly more postoperative pain than simple implant surgeries [2] But Al‐Khabbaz et al. demonstrated that bone augmentation was not associated with postoperative pain [3], González‐Santana et al. found that GBR was significantly related to the degree of postoperative swelling but may not be associated with postoperative pain [4] However, these studies are observational studies and included various bone augmentation techniques, such as ridge preservation, GBR, osteotome technique and maxillary sinus augmentation. Therefore, there is a lack of controlled studies evaluating the effect of GBR on postoperative pain as a separate factor.
Therefore, this study was designed as a prospective controlled clinical trial to investigate the duration and strength of postoperative pain after dental implant placement with and without guided bone regeneration, aiming to optimize postoperative pain management and enhance patients' satisfaction.
2. Materials & Methods
2.1. Research Participants
With ethics committee approval, 72 patients with single tooth loss seeking implant restoration who visited the Implantology Department of Dental Hospital between February 2021 and August 2023 were included in the study. The patients were divided into two groups based on the bone volume: Group A and Group B. Specifically, a bone width of more than 7 mm in the central incisor and molar regions was considered adequate, and a width of more than 6 mm in the other anterior teeth and premolar teeth regions was also considered adequate in common conditions. And if bone defect existed on the labial (buccal) or palatal side of the alveolar, these patients were classified into the Group B.
Inclusion criteria: single tooth loss; good cognitive and communication skills.
Exclusion criteria: contraindications to implant surgery (e.g., uncontrolled diabetes and hypertension); type I or IV bone quality (Lekholm and Zarb classification); a combination of other procedures (e.g., tooth extraction, soft‐tissue augmentation, maxillary sinus floor elevation and bone block grafting); the presence of preoperative head, facial pain or toothache; anxiety or extreme sensitivity to pain; and failure to cooperate in completing the postoperative follow‐up owing to the administration of analgesics or other reasons.
2.2. Materials and Instruments
The materials and instruments used in the study included implants (Straumann, Switzerland; WeGo, China), deproteinized bovine bone mineral (Geistlich, Switzerland), resorbable collagen membranes (Geistlich, Switzerland), an implant machine (WH, Austria) and an implant handpiece (WH, Austria).
2.3. Methods and Procedures
2.3.1. Pre‐Operation
All patients underwent a routine preoperative examination, assessment of bone volume and bone quantity. The State–trait anxiety inventory (STAI) [5] and pain sensitivity questionnaire (PSQ) [6] were done. And the identified patients with anxiety(S‐AI > 40) or high pain sensitivity (PSQ‐total > 5) [7] were excluded. For the other patients, informed consent was obtained, and the participants' basic information, such as age, sex and surgical information like implant systems and location, were recorded.
2.3.2. Surgery
All procedures were performed by the same experienced surgeon. The following steps were performed for the Group A: local infiltration anaesthesia with 4% articaine (containing 1:100000 epinephrine), flap reflection followed by pilot drill positioning, bone preparation, implant placement, and submerged or non‐submerged healing. Data including implant systems and sites were recorded.
The following steps were performed for the Group B: local infiltration anaesthesia with 4% articaine (containing 1:100000 epinephrine), a mucoperiosteal flap was raised by means of a midcrestal incision, sulcular incisions at both neighbouring teeth and a vertical parapapillary releasing incision at the distal neighbouring tooth, localization of the pilot drill under direct vision, bone preparation, decortication, implant placement, bone graft bed surface covering with particulate deproteinized bovine bone mineral (Bio‐Oss, 0.25 g, Geistlich, Switzerland) and resorbable collagen membrane (Bio‐Gide, 13 × 25 mm, Geistlich, Switzerland), then the flap was released to achieve tension‐free closure and submerged healing. Implant system and implant site were recorded.
2.3.3. Post‐Operation
All patients were administered postoperative prophylactic antibiotics (cefuroxime) for 3 days and chlorhexidine mouthwash for gargling for 7 days. Given that previous studies have shown mild levels of postoperative pain [3, 4, 8, 9, 10] patients were not advised to take analgesics before and immediately after the surgery. If postoperative pain was unbearable, patients were allowed to take ibuprofen, and they were instructed to record the number of tablets taken and the duration of use. Besides, Khouly's study showed that postoperative pain mainly occurred in the first 72 h following dental implant placement [11] Therefore, we arranged a specific investigator who was single‐blinded to follow up patients by telephone for 3 days. Follow‐ups were conducted at 2, 4, 6, 24, 48 and 72 h postoperatively, and patients expressed real‐time pain levels via the numerical rating scale (NRS) [12, 13, 14]. And if they have already taken painkillers, they were asked to inform the investigator of the medication information.
2.4. Statistical Analysis
SPSS version 26.0 (IBM Corp., Armonk, NY, USA) was used to statistically analyse the general information and between‐group differences in pain data. Between‐group differences for categorical variables were evaluated using the chi‐squared test or Fisher's exact probability method, and between‐group differences for continuous variables were evaluated using the independent samples t‐test (normality and chi‐squared tests were performed first). Two‐way analysis of variance (two‐way ANOVA) and covariate analysis of variance (ANCOVA) were used to further confirm the influence of confounding factors with differences between the two groups. p‐values < 0.05 were considered statistically significant.
3. Results
Patients lost to follow‐up (8 patients) and those who were over‐anxious (4 patients) were excluded. Hence, a total of 60 patients were included in the statistical analysis: 30 patients each in Group A and Group B. Among them, 29 patients were male and 31 patients were female, with ages ranging from 17 to 79 years. The incidence of postoperative pain was 100%. And 22 patients (36.37%) took the analgesics (3 patients in Group A and 19 patients in Group B). The general characteristics of the two groups are shown in Table 1.
TABLE 1.
Comparison of general information between Group A and Group B.
| Factors | Group A | Group B | p | 95% CI/Ф | |
|---|---|---|---|---|---|
| Ageα | 49.63 ± 13.05 | 36.53 ± 11.66 | < 0.001 | [6.71,19.50] | |
| Sexβ | 0.203 | 0.167 | |||
| Male | 12 (20%) | 17 (28.33%) | |||
| Female | 18 (30%) | 13 (21.67%) | |||
| Anxietyβ | 31.13 ± 4.72 | 31.10 ± 4.21 | 0.977 | [−2.28, 2.34] | |
| PSQα | 3.99 ± 1.41 | 4.07 ± 1.06 | 0.806 | [−0.72, 0.57] | |
| Implant systemβ | 0.591 | 0.071 | |||
| Straumann | 19 (31.67%) | 21 (35%) | |||
| Wego | 11 (18.33%) | 9 (15%) | |||
| Implant locationβ | 0.009 | 0.336 | |||
| Maxillary | 12 (20%) | 22 (36.67%) | |||
| Mandible | 18 (30%) | 8 (13.33%) | |||
| Implant positionβ | 0.147 | −0.364 | |||
| Anterior teethγ | 4 (6.67%) | 14 (23.33%) | |||
| Posterior teeth | 26 (43.33%) | 16 (26.67%) | |||
| Duration of surgery (hour)α | 0.49 ± 0.20 | 0.81 ± 0.23 | < 0.001 | [−0.43, −0.21] | |
| Incision size (mm)α | 9.33 ± 1.35 | 17.87 ± 2.34 | < 0.001 | [−9.52, −7.54] | |
Note: α is the measure, the values in the table are the mean ± standard deviation and 95% CI. β is the count, the values in the table are the frequency (percentage) and effect size Ф. γ anterior teeth means the teeth between canines.
There were no statistically significant differences (p > 0.05) between Group A and Group B in terms of general information (sex, anxiety, implant system and anterior and posterior implant positions) (Table 1). The mean age in Group A was higher than it was in Group B (p < 0.001, 95% CI [6.71, 19.5]). Participants in Group B received implant placement in the maxilla more than in the mandible, while it was just the opposite in Group A (p = 0.009, effect size Ф = 0.336). Besides, the incision size in the Group B was larger and the operation duration was longer than Group A (p < 0.001, 95% CI [−9.52, −7.54]).
The trends of postoperative pain in Group A and Group B are shown in Figure 1.
FIGURE 1.
Trends in postoperative pain for Group A (single dental implant placement) and Group B (single dental implant placement with GBR simultaneously). Y‐axis depicts the postoperative pain score by numerical rating scale, and the data are presented by mean ± SD.
As depicted in the graph, the trend of postoperative pain was the same in implant surgery with and without GBR. The pain peak appeared at 4 h post‐operation and decreased over time thereafter. Furthermore, the pain tended to disappear 48 h postoperatively. The postoperative pain intensity in Group B was higher than that in Group A, and the between‐group difference was more obvious within 24 h. The specific pain scores for each period between the two groups are compared in Table 2.
TABLE 2.
Pain intensity by time period between different groups.
| Time (postoperative) | Group A | Group B | P value (95% CI) |
|---|---|---|---|
| 0 h | 0.27 ± 0.24 | 0.30 ± 0.19 | 0.895 (−0.44, 0.31) |
| 2 h | 2.67 ± 1.56 | 3.43 ± 1.72 | 0.075 (−1.61, 0.08) |
| 4 h | 2.93 ± 1.95 | 4.77 ± 2.46 | 0.002 (−2.98, −0.69) |
| 6 h | 2.07 ± 1.26 | 3.60 ± 2.01 | 0.001 (−2.40, −0.67) |
| 24 h | 0.37 ± 0.27 | 1.00 ± 0.38 | 0.003 (−1.05, −0.22) |
| 48 h | 0.10 ± 0.21 | 0.20 ± 0.28 | 0.343 (−0.31, 0.11) |
| 72 h | < 0.01 ± 0.00 | 0.10 ± 0.11 | 0.078 (−0.21, 0.01) |
The peak postoperative pain in Group B was 4.77, which indicated moderate pain; however, the pain intensity significantly decreased to mild pain after 24 h (Table 2). In contrast, the peak postoperative pain in Group A was 2.93, which indicated mild pain. The pain scores in Group B were significantly higher than those in Group A at 4, 6 and 24 h postoperatively (p = 0.002, 0.001 and 0.003, 95% CI = [−2.98, −0.69], [−2.40, −0.67] and [−1.05, −0.22], respectively). There was no significant difference in the pain scores between the two groups at any other time (p > 0.05).
Moreover, significant differences had been found in age, implant location, duration of surgery and incision size between Group A and B in the comparison of general information between two groups (Table 1). Under normal circumstances, it can be understood that the surgery duration of Group B is usually longer than that of Group A, and the incision size of Group B is usually larger than that of Group A. However, variables such as age and implant location, which are not necessarily related to GBR, also differed between the two groups. In order to determine whether the two variables have an impact on postoperative pain in patients who underwent dental implant insertion with or without GBR, the analysis results of confounding factors are as follows (Tables 3 and 4).
TABLE 3.
Two‐Way ANOVA of implant location and GBR on postoperative pain.
| Postoperative pain | Modified model | GBR | Implant location |
|---|---|---|---|
| 2 h | 0.158 (0.063) | 0.154 (0.035) | 0.456 (0.010) |
| 4 h | 0.004 a (0.177) | 0.013 a (0.104) | 0.175 (0.032) |
| 6 h | 0.002 a (0.192) | 0.004 a (0.137) | 0.326 (0.017) |
| 24 h | 0.006 a (0.163) | 0.016 a (0.098) | 0.215 (0.027) |
| 48 h | 0.165 (0.061) | 0.724 (0.002) | 0.101 (0.046) |
| 72 h | 0.127 (0.070) | 0.184 (0.031) | 0.309 (0.018) |
Note: the values in the table are p value and effect size (partial η2).
p < 0.05.
TABLE 4.
Analysis of covariance (ANCOVA) between age and postoperative pain.
| Postoperative pain | Modified model | GBR | Age |
|---|---|---|---|
| 2 h | 0.178 (0.059) | 0.194 (0.029) | 0.571 (0.006) |
| 4 h | 0.001 a (0.231) | 0.018 a (0.095) | 0.081 (0.053) |
| 6 h | 0.003 a (0.184) | 0.007 a (0.120) | 0.504 (0.008) |
| 24 h | 0.011 a (0.147) | 0.022 a (0.089) | 0.486 (0.009) |
| 48 h | 0.084 (0.083) | 0.916 (0.000) | 0.145 (0.069) |
| 72 h | 0.135 (0.068) | 0.266 (0.022) | 0.339 (0.016) |
Note: The values in the table are p value and effect size (partial η2).
p < 0.05.
From the above table, we can see that simultaneous GBR with dental implant surgery has an impact on postoperative pain at 4, 6 and 24 h, which is consistent with the results of the univariate analysis (Table 2). And the implant location has no effect on postoperative pain at any time.
In Table 4, it can be seen that GBR has an impact on postoperative pain at 4 h, 6 h and 24 h, while age has no significant effect on postoperative pain.
By monitoring the status of taking painkillers in two groups (Figure 2), we found that the number of patients, tablets and days in Group B were higher than Group A. And the patients' pain was significantly relieved after taking painkillers. The specific postoperative pain intensity of patients taking painkillers or not is shown in Table 5, and the Figure 3 shows the trends in postoperative pain for patients taking painkillers or not in Group A and Group B.
FIGURE 2.
Histogram shows the differences of taking painkillers between Group A (single dental implant placement) and Group B (single dental implant placement with GBR simultaneously) in the number of patients, tables and days.
TABLE 5.
Comparison of postoperative pain between patients taking painkillers or not in Group A and Group B.
| Postoperative pain | Patients taking painkillers | Patients not taking painkillers | ||||
|---|---|---|---|---|---|---|
| Total (P, n = 22) | Group A (P‐A, n = 3) | Group B (P‐B, n = 19) | Total (NP, n = 38) | Group A (NP‐A, n = 27) | Group B (NP‐B, n = 11) | |
| 2 h | 4.59 | 4 | 4.68 | 2.89 | 2.52 | 3.82 |
| 4 h | 4.05 | 6.67 | 3.63 | 3.18 | 2.52 | 4.82 |
| 6 h | 1.77 | 2 | 1.74 | 2.55 | 2.07 | 3.73 |
| 24 h | 0.91 | 0.67 | 0.95 | 0.55 | 0.33 | 1.09 |
| 48 h | 0.09 | 0.33 | 0.05 | 0.18 | 0.07 | 0.45 |
| 72 h | 0 | 0 | 0 | 0.08 | 0 | 0.27 |
FIGURE 3.
Trends in postoperative pain for patients taking painkillers or not in Group A and Group B: P for Patients taking painkillers, P‐A for Patients taking painkillers in Group A, P‐B for Patients taking painkillers in Group B, NP for Patients not taking painkillers, NP‐A for Patients not taking painkillers in Group A, NP‐B for Patients not taking painkillers in Group B. And the data presented the mean NRS score of each group.
From the above information, we can see that compared with the patients taking painkillers (P), the patients who didn't take painkillers (NP) have a lower peak value of the postoperative pain. And the pain intensity of the patients taking painkillers decreased rapidly and was lower than that of the non‐medication patients by 6 h after surgery. Among patients taking painkillers, the pain intensity in Group B (P‐B) was higher than that in Group A (P‐A) at 2 h after surgery, and then began to decrease, which may be due to the patients who suffered simultaneous GBR and dental implant placement surgery (P‐B) taking painkillers earlier. According to the experimental design, patients took painkillers when they felt that the pain was unbearable after surgery. Moreover, among patients who did not take medication, the postoperative pain intensity in Group B (NP‐B) was significantly higher than in Group A (NP‐A).
4. Discussion
In recent years, the development of dental implant restorations and the concept of ‘comfort dentistry’ have led to increased attention to postoperative pain after dental implant surgery. Pain, as an intuitive and subjective feeling, directly affects a patient's experience and satisfaction, making it an important criterion for patients to judge whether a treatment was successful. Studying postoperative pain after dental implant surgery deepens our understanding of postoperative pain and improves pain control and management.
Previous research has identified several factors that may influence post‐implant pain, including anxiety [15, 16, 17, 18, 19, 20] pain sensitivity [17], flaps [17, 21, 22, 23], operator experience [3] and the number of implants [4] To eliminate these factors, this study only included cases of single tooth loss operated by the same surgeon with a flap design and excluded patients with anxiety and high pain sensitivity. Postoperative pain assessment was performed in real time using the NRS digital scale [24], which is comparable to the visual analogue scale but is more convenient to operate [25] effectively reduces recall bias [26] and improves the accuracy of the assessment.
Studies have shown that the overall incidence of postoperative pain after dental implant surgery ranges from 57% to 100% [3, 4, 27, 28]. In this study, the incidence was 100%, which may be due to the operation of flap reflection in all the cases [21]. The peak of postoperative pain occurred at 4 h postoperatively in this study, which is consistent with the reports of the study by Rebecca [28] However, González et al. suggested peaks at 6 h postoperatively [4] and some studies suggested that the peak of postoperative pain occurred at 24 h postoperatively [3, 10, 21, 29]. The differences in the timing of the peak of pain in different studies may be due to the different follow‐up intervals in different studies, doses of local anaesthetics injected by different operators, operating times and metabolic rates caused by differences in the body composition between humans.
Postoperative pain after dental implant surgery is mainly caused by the inflammatory response to the tissue damage of the surgery and trans‐sensitization of surrounding nerves. In this study, the pain intensity reflected in the Group B was higher than that in the Group A, whether in terms of NRS value or the number of patients, tablets and days of taking painkillers, and the possible reasons for this are as follows. First, the incision in the Group B was larger, and the mechanical stimulation of the incision activated the Aδ fibres and C fibres [30, 31], leading to nociceptive sensitization. Second, the surgery duration in Group B was longer, and the elevated lactate concentration due to ischemia in the incision caused more postoperative pain [32, 33] Third, there was usually a periosteal hypotonic incision in Group B, and the periosteal nerves are more abundant; hence, the stimulated release of bradykinin, CGRP, 5‐hydroxytryptamine, substance P, NGF and carbon monoxide from nerve endings lowers the threshold of afferent nociceptive receptors in peripheral nerve endings, resulting in increased peripheral nerve sensitivity [34]. Fourth, postoperative swelling was more pronounced in Group B [4, 35], and this increased tissue pressure in the operative area and more pain.
The results of this study indicate that age and implant location have no effect on postoperative pain. Previous researches [3, 17] suggest that there is no significant correlation between implant location and postoperative pain. This is consistent with our conclusion. As for the effect of age on postoperative pain, scholars' views are not completely unified. Al Khabbaz et al. found age was related to pain intensity one week after dental implant surgery, but not related to pain intensity 24 h after dental implant surgery [3], nevertheless, other studies have shown no correlation between age and postoperative pain following dental implant insertion [4, 17, 36].
This study had some limitations. First, for ethical reasons, the study did not stricty prohibit the use of analgesics in the included population but only monitored the information of taking painkillers, which may have led to some bias. Second, due to the varying intensity of pain that patients can tolerate before taking painkillers the different start times and duration, it's difficult to accurately quantify the impact of medication on pain. In terms of qualitative description, taking analgesics can effectively alleviate the postoperative pain to an acceptable level. Fortunately, no matter whether reflected by pain value or the monitoring data on medication, we can draw a consistent conclusion that the pain intensity in the GBR group is higher than that in the control group.
5. Conclusion
Combined with the results of this study, patients who underwent guided bone regeneration simultaneously experienced higher postoperative pain, and more than half of the patients need to take analgesic medications. Therefore, taking analgesic medications before the peak of postoperative pain (such as within 2 h after surgery) designedly may be sufficient for post‐operative pain management in dental implant surgery with GBR in order to enhance their postoperative comfort and satisfaction and decrease potential adverse effects.
Author Contributions
Study design and conceptualization: Xu Gao, Meijie Wang, Yue Deng. Statistical analysis: Xu Gao, Xuejian Zhang, Yan Wang. Interpretation of data: Yan Wang, Xuejian Zhang. Drafting and revision of manuscript: Xu Gao, Meijie Wang, Yue Deng. Review of manuscript: All authors approved the final version of the manuscript.
Funding
This work was supported by Correlation Exploration of the surgical factors and postoperative pain after dental implantation (2020‐WIZD144). Qingdao Key Medical and Health Discipline Project (2025–2027). Shandong Provincial Key Medical and Health Discipline of Oral Medicine (Qingdao University Affiliated Qingdao Stomatological Hospital) 2025–2027.
Ethics Statement
This study was approved by the Ethics Committee of the Qingdao Stomatological Hospital (Approval number: 2020KQYX017).
Consent
Informed consent was obtained from all participants for being included in the study.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
We are grateful for the kind cooperation of Chuanrong Yin, Dr. Junzhao Gao and Dr. Fangshuo Wang for the collection of the data. And the research was supported by Qingdao Key Medical and Health Discipline Project (2025–2027), Shandong Provincial Key Medical and Health Discipline of Oral Medicine (Qingdao University Affiliated Qingdao Stomatological Hospital) 2025–2027, Correlation Exploration of the surgical factors and postoperative pain after dental implantation (2020‐WIZD144).
Data Availability Statement
The data that support the findings of this study are available from the corresponding author (Meijie Wang) upon reasonable request.
References
- 1. AlQutub A. W., “Pain Experience After Dental Implant Placement Compared to Tooth Extraction,” International Journal of Dentistry 31, no. 8 (2021): 1–5, 10.1155/2021/4134932. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Mei C. C., Lee F. Y., and Yeh H. C., “Assessment of Pain Perception Following Periodontal and Implant Surgeries,” Journal of Clinical Periodontology 43, no. 12 (2016): 1151–1159, 10.1111/jcpe.12618. [DOI] [PubMed] [Google Scholar]
- 3. Al‐Khabbaz A. K., Griffin T. J., and Al‐Shammari K. F., “Assessment of Pain Associated With the Surgical Placement of Dental Implants,” Journal of Periodontology 78, no. 2 (2007): 239, 10.11607/jomi.2713. [DOI] [PubMed] [Google Scholar]
- 4. González‐Santana H., Peñarrocha‐Diago M., Guarinos‐Carbó J., and Balaguer‐Martínez J., “Pain and Inflammation in 41 Patients Following the Placement of 131 Dental Implants,” Medicina Oral, Patología Oral y Cirugía Bucal 10, no. 3 (2005): 258–263. [PubMed] [Google Scholar]
- 5. Spielberger C., STAI Manual for the State‐Trait Anxiety Inventory. Self‐Evaluation Questionnaire, vol. 4 (Self‐Evaluation Questionnaire, 1983), 1–24. [Google Scholar]
- 6. Ruscheweyh R., Marziniak M., Stumpenhorst F., Reinholz J., and Knecht S., “Pain Sensitivity Can Be Assessed by Self‐Rating: Development and Validation of the Pain Sensitivity Questionnaire,” Pain 146, no. 1–2 (2009): 65–74, 10.1016/j.pai.2009.06.020. [DOI] [PubMed] [Google Scholar]
- 7. Quan X., Fong D. Y. T., Leung A. Y. M., Liao Q., Ruscheweyh R., and Chau P. H., “Validation of the Mandarin Chinese Version of the Pain Sensitivity Questionnaire,” Pain Practice 18, no. 2 (2018): 180–193, 10.1111/papr.12587. [DOI] [PubMed] [Google Scholar]
- 8. Gomez‐De D. R., Cutando‐Soriano A., Montero‐Martin J., and López‐Valverde A., “State Anxiety and Depression as Factors Modulating and Influencing Postoperative Pain in Dental Implant Surgery. A Prospective Clinical Survey,” Med. Oral Patol Oral Cir Bucal 19, no. 6 (2014): e592‐e597, 10.4317/medoral19685. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Rajeswari R., Gowda T. M., and Arya K., “Analgesic Efficacy and Safety of Transdermal and Oral Diclofenac in Postoperative Pain Management Following Dental Implant Placement,” General Dentistry 65, no. 4 (2017): 69–74. [PubMed] [Google Scholar]
- 10. Hashem A. A., Claffey N. M., and O'Connell B., “Pain and Anxiety Following the Placement of Dental Implants,” International Journal of Oral & Maxillofacial Implants 21, no. 6 (2006): 943–950. [PubMed] [Google Scholar]
- 11. Khouly I., Braun R. S., and Ordway M., “Post‐Operative Pain Management in Dental Implant Surgery: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials,” Clinical Oral Investigations 25, no. 5 (2021): 2511–2536, 10.1007/s00784-021-03859. [DOI] [PubMed] [Google Scholar]
- 12. Castarlenas E., Jensen M. P., and von Baeyer C. L., “Psychometric Properties of the Numerical Rating Scale to Assess Self‐Reported Pain Intensity in Children and Adolescents: A Systematic Review,” Clinical Journal of Pain 33, no. 4 (2017): 376–383, 10.1097/AJP.0000000000000406. [DOI] [PubMed] [Google Scholar]
- 13. Sharma S., Palanchoke J., and Reed D., “Translation, Cross‐Cultural Adaptation and Psychometric Properties of the Nepali Versions of Numerical Pain Rating Scale and Global Rating of Change,” Health and Quality of Life Outcomes 15, no. 1 (2017): 236, 10.1186/s12955-017-0812-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Haye R., Døsen L. K., and Tarangen M., “Good Correlation Between Visual Analogue Scale and Numerical Rating Scale in the Assessment of Nasal Obstruction,” Journal of Laryngology and Otology 132, no. 4 (2018): 327–328, 10.1017/S002215118000257. [DOI] [PubMed] [Google Scholar]
- 15. Eli I., Schwartz‐Arad D., Baht R., and Ben‐Tuvim H., “Effect of Anxiety on the Experience of Pain in Implant Insertion,” Clinical Oral Implants Research 14, no. 1 (2003): 115–118, 10.1034/J.1600-0501.2003.140115. [DOI] [PubMed] [Google Scholar]
- 16. Dao J. F., Zhang J. C., and Song G. B., “Effect of Preoperative Anxiety Level on Postoperative Pain Sensation in Patients Receiving Implant Denture for Partial Edentulism,” J S Med Uni 34, no. 4 (2014): 528–531. [PubMed] [Google Scholar]
- 17. Wang M., Li Y., and Li J., “The Risk of Moderate‐To‐Severe Postoperative Pain Following the Placement of Dental Implant,” Journal of Oral Rehabilitation 46, no. 5 (2019): 836–844, 10.1111/joor.12815. [DOI] [PubMed] [Google Scholar]
- 18. Kim S., Lee Y. J., Lee S., Moon H. S., and Chung M. K., “Assessment of Pain and Anxiety Following Surgical Placement of Dental Implants,” International Journal of Oral & Maxillofacial Implants 28, no. 2 (2013): 531–535, 10.11607/jomi.2713. [DOI] [PubMed] [Google Scholar]
- 19. Ghobadi A., Moradpoor H., Sharini H., et al., “The Effect of Virtual Reality on Reducing Patients' Anxiety and Pain During Dental Implant Surgery,” BMC Oral Health 24 (2024): 186, 10.1186/s12903-024-03904-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Lopez‐Lopez J., Ramezanzade S., Atabaki M. S., et al., “Psychologic Status and Influence of Surgery Techniques on Acute Nonneuropathic Pain After Dental Implant Surgery: Systematic Review and Meta‐Analyses,” Quintessence 36, no. 2 (2021): 248–269, 10.11607/JOMI.8300. [DOI] [PubMed] [Google Scholar]
- 21. Fortin T., Bosson J. L., Isidori M., and Blanchet E., “Effect of Flapless Surgery on Pain Experienced in Implant Placement Using an Image‐Guided System,” International Journal of Oral & Maxillofacial Implants 21, no. 2 (2006): 298–304. [PubMed] [Google Scholar]
- 22. Zheng X. B. and Huang X. Y., “Comparison of Effects of Minimally Invasive Flapless and Conventional Flap Implant Surgery on Dental Implant Effect and Patient Pain Degree,” Health Way 3 (2018): 120. [Google Scholar]
- 23. Romandini M., Ruales‐Carrera E., Sadilina S., Hammerle C., and Sanz M., “Minimal Invasiveness at Dental Implant Placement: A Systematic Review With Meta‐Analyses on Flapless Fully Guided Surgery,” Periodontology 2000 9 (2022): 1, 10.1111/prd.12440. [DOI] [PubMed] [Google Scholar]
- 24. Modarresi S., Lukacs M. J., and Ghodrati M., “A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain,” Clinical Journal of Pain 38, no. 2 (2022): 132–148, 10.1097/AJP.0000000000999. [DOI] [PubMed] [Google Scholar]
- 25. Shiffman S., Stone A. A., and Hufford M. R., “Ecological Momentary Assessment,” Annual Review of Clinical Psychology 4 (2008): 1–32, 10.1146/annrev.clinpsy.3.022806.091415. [DOI] [PubMed] [Google Scholar]
- 26. Kikuchi H., Yoshiuchi K., Miyasaka N., Ohashi K., and Akabayashi A., “Reliability of Recalled Self‐Report on Headache Intensity: Investigation Using Ecological Momentary Assessment Technique,” Cephalalgia 26 (2006): 1335–1343, 10.1111/j.1468-2982.2006.01221.x. [DOI] [PubMed] [Google Scholar]
- 27. Jotta Seferli M. M., Björn K., and Lena W., “Patients´ Experiences of Dental Implant Placement for Treatment of Partial Edentulism in a Student Clinic Setting,” Swedish Dental Journal 38, no. 2 (2014): 77–85. [PubMed] [Google Scholar]
- 28. Rebecca B., Jonathan K., and Andres P., “Characterization and Treatment of Postsurgical Dental Implant Pain Employing Intranasal Ketorolac,” Compendium of Continuing Education in Dentistry 34, no. 8 (2013): 570–576. [PubMed] [Google Scholar]
- 29. Muller E. and Ríos Calvo M. P., “Pain and Dental Implantology: Sensory Quantification and Affective Aspects. Part i: At the Private Dental Office,” Implant Dentistry 10, no. 1 (2001): 14–22, 10.1097/00008505-200101000-00007. [DOI] [PubMed] [Google Scholar]
- 30. Pogatzki E. M., Gebhart G. F., and Brennan T., “Characterization of a Delta‐ and c‐Fibers Innervating the Plantar Rat Hindpaw One Day After an Incision,” Journal of the Peripheral Nervous System 7, no. 3 (2002): 721, 10.1152/jn.00208.2001. [DOI] [PubMed] [Google Scholar]
- 31. Zahn P. K., Pogatzki E. M., and Brennan T. J., “Mechanisms for Pain Caused by Incisions,” Regional Anesthesia and Pain Medicine 27, no. 5 (2002): 514, 10.1053/rapm.2002.35155. [DOI] [PubMed] [Google Scholar]
- 32. Kim T. J., Freml L., Park S. S., and Brennan T. J., “Lactate Concentrations in Incisions Indicate Ischemic‐Like Conditions May Contribute to Postoperative Pain,” Journal of Pain 8, no. 1 (2007): 59–66, 10.1016/j.jpain.2006.06.003. [DOI] [PubMed] [Google Scholar]
- 33. Reissmann D., Poulopoulos G., and Durham J., “Patient Perceived Burden of Implant Placement Compared to Surgical Tooth Removal and Apicectomy,” Journal of Dentistry 43, no. 12 (2015): 1456–1461, 10.1016/j.jdent.2015.10.012. [DOI] [PubMed] [Google Scholar]
- 34. Dong R., Yu B., Chen L., and Yu W., “The 5‐ht2areceptor Potassium‐Chloride Cotransporter 2 Signaling Pathway in a Rat Incision Pain Model,” Experimental and Therapeutic Medicine 12, no. 6 (2016): 3583–3588, 10.3892/etm.2016.3807. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35. Yao J., Lee K., McGrath C., and Mattheos N., “Comparison of Patient‐Centered Outcomes After Routine Implant Placement, Teeth Extraction, and Periodontal Surgical Procedures,” Clinical Oral Implants Research 28, no. 4 (2016): 373–380, 10.1111/clr.12794. [DOI] [PubMed] [Google Scholar]
- 36. Ryuta K., Hajime M., Emilio S., et al., “A Risk Factor Analysis of Accumulated Postoperative Pain and Swelling Sensation After Dental Implant Surgery Using a Cellular Phone‐Based Real‐Time Assessment,” Journal of Prosthodontic Research 59, no. 3 (2015): 194–198, 10.1016/j.jpor.2015.05.003. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author (Meijie Wang) upon reasonable request.