Protocols in implant surgery have achieved high levels of safety and repeatability and are, therefore, part of the clinical routine of any dental facility. Precisely for this reason, an objective of improvement is to control the small problems that can still be encountered in daily practice.
For example, it is quite normal for the patient to experience complications such as pain and swelling in the area of implant surgery. These are related symptoms, approximately parallel in nature, the severity of which depends directly on the damage to the tissues. The pain symptom is generally mild or moderate and reaches its maximum on the day of surgery. The tissues experience mild swelling (it may be more important, following operations such as sinus lift with placement of bone substitute).
Several authors have questioned whether these consequences are also related to patient-related factors, such as age or gender, with a particular interest in modifiable ones (e.g. smoking habit).
A few years ago, Mariano Sánchez-Siles’ working group wondered if there could be a correlation with local anaesthetic drugs, essential for the success of the intervention, but potentially subject to excessive use, also because of the typically high toxicity threshold and the few direct complications.
The survey was set up as a prospective study, comprising a pool of 100 patients (55 males and 45 females) aged between 19 and 80 years. Each was treated with the insertion of a single implant of the same type (internal connection diameters ranging from 3.6 to 5.4 mm and lengths between 10 and 14 mm) with an operation conducted by a single surgeon according to the same protocol – crest incision without discharge (releasing incisions), drilling, two stitches.
As for the anaesthesiological pre-treatment, the patients were assigned to one of the two equinumerous groups: group A received 0.9 mL, corresponding to half a cartridge, of articaine; group B received 7.2 mL instead, corresponding to four tube vials, of the same solution.
The patients were all subject to antibiotic coverage (amoxicillin 500 mg, 3 times a day for 6 days) and were prescribed an anti-inflammatory drug on request (ibuprofen 600 mg).
Each patient completed the Corah® questionnaire on dental anxiety before surgery, an assessment of intraoperative pain using visual analogue scales (VAS) immediately after surgery, and then independently assessed pain and swelling at 2, 6 and 12 hours on the same day, then daily for up to one week. At the end of the postoperative period, a questionnaire, assessing overall satisfaction, was submitted.
Confirming the expectations of the experimenters, the two groups showed a similar intraoperative pain score, while the patients of group B reported a significantly higher discomfort for all 7 days of postoperative monitoring.
In conclusion, it can be said that an administration of an excessive volume of local anaesthetic solution in implant surgery can increase postoperative pain without, however, bringing benefits for the control of intraoperative pain. It will be useful for the clinician to use techniques and methods that can monitor and, possibly, reduce the amount of medication to be used.