Pharmacology plays a vital role in the field of dental implants
The success of dental implant treatment relies on various skills including the ability to plan surgical cases safely, raise flaps, suture, manipulate bone and soft tissue and manage healing and complications appropriately. Another important factor is the dental clinician’s knowledge of pharmacology and the effective use of medication.
A variety of pharmaceutical drugs are used throughout the different stages of such treatment, from the initial implant surgery to the final restoration and dental clinicians need to be aware of their modes of action to improve implant success and avoid unnecessary complications.
During the surgical phase of dental implantology, certain drugs are used to ensure patient comfort and control pain and anxiety. Local anaesthesia, such as lidocaine,[i] helps in minimising the pain and discomfort associated with the procedure. Adrenaline is often added as a vasoconstrictor to lidocaine and articaine cartridges, which enhances the effect of anaesthetics and reduces the dose required.[ii] Additionally, sedative drugs, such as benzodiazepines,[iii] may be prescribed to help patients relax during the surgery.
Infection prevention
Pharmaceuticals are also important in the pre- and post-operative care of dental implant patients. Antibiotics are commonly prescribed before and after the implant surgery to prevent infections.[iv] It should be noted that prophylactic antibiotic use is not recommended in otherwise healthy individuals but may be required in those with risk factors and/or co-morbidities.[v]
The choice of antibiotic depends on the patient’s medical history and the specific needs of the procedure. Commonly used antibiotics include amoxicillin, clindamycin,[vi] and metronidazole.[vii] These medications help in reducing the risk of infection, which can significantly impact the success of dental implant osseointegration.[viii]
In addition to antibiotics, analgesic drugs are prescribed to manage post-operative pain. Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, are commonly used to alleviate pain and reduce inflammation.[ix] It is important to choose the appropriate dosage and duration of analgesic use to avoid any adverse effects.[x]
Pain relief
For mild dental pain, 200mg to 400mg of ibuprofen every 4-6 hours is recommended and may be increased to 600ml to provide greater pain relief, though such a dosage increase is accompanied by elevated gastrointestinal and cardiovascular risks. Naproxen has a longer duration and a stronger anti-inflammatory effect than ibuprofen. However, it has a higher risk of adverse effects such as gastrointestinal toxicity.ix
Pharmacology plays a crucial role in the management of complications and implant failure in dental implantology. For example, if a patient develops peri-implantitis, the use of antimicrobial agents becomes essential. Antimicrobial mouthwashes, like those containing chlorhexidine (CHX), can be prescribed to control and treat peri-implantitis. These mouthwashes help in reducing bacterial load, preventing further infection and promoting tissue healing.[xi]
CHX has indications at several different stages of dental implant treatment including as a pre-surgical mouth rinse to reduce the oral microbial load for 7-10 days prior to surgery and for post-operative protocols involving application of pressure for 30 minutes with gauze soaked in it for up to 14 days after surgery to aid healing.x
Managing complications
In cases where osseointegration is not successful, pharmacological agents such as growth factors and bone stimulants may be utilised. These agents promote bone healing and regeneration, facilitating the integration of the implant with the jawbone. Bone morphogenetic proteins are commonly used to enhance bone formation around dental implants. These proteins can play a crucial role in bone development and can significantly improve the chances of successful implant outcomes.[xii]
Additionally, pharmacology is important in managing complications related to medical conditions that patients may have, or the medications they take. Dental clinicians need to carefully assess a patient’s medical history, including any existing conditions and medications, to ensure the safe use of particular drugs during treatment. For example, patients who are on anticoagulant therapy – such as warfarin – may require a specific treatment protocol to reduce the risk of bleeding during the surgery.[xiii]
The relevance of pharmacology in implant dentistry forms part of the Anatomy and Physiology module in the new Post-Graduate Diploma in Implant Dentistry from the Straumann Group brand Anthogyr,® in conjunction with training academy Implant Conneqt and awarded by EduQual. Aimed at clinicians who are new to dental implants or who need more experience, the course guarantees delegates place and restore up to 10 dental implants. Comprising 13 modules (including eight clinical days and one residential module), with access to theory sessions online, one-to-one support and clinical supervision, dental professionals can enrol at any time. See the Anthogyr® website for full details about this exciting opportunity.
Pharmacology plays a significant role in dental implantology. The use of certain pharmaceutical drugs ensures patient comfort, controls pain and anxiety during the surgical phase, prevents and treats infections, manages complications, and enhances the success of dental implant procedures. Dental clinicians therefore must have a thorough understanding of pharmacology and its applications to provide safe and effective care for their patients seeking dental implant treatment.
For more details, please visit
https://www.straumann.com/anthogyr/en/home.html
[i] Beecham GB, Nessel TA, Goyal A. Lidocaine. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539881/ [Accessed January 2024]
[ii] Ito T, Utsumi N, Baba Y, Matsumura T, Wakita R, Maeda S. Considerations for Satisfactory Sedation during Dental Implant Surgery. J Pers Med. 2023 Mar 1;13(3):461. doi: 10.3390/jpm13030461. PMID: 36983643; PMCID: PMC10054855. [Accessed January 2024]
[iii] NHS https://www.nhsinform.scot/healthy-living/drugs-and-drug-use/common-drugs/benzodiazepines-benzos-diazepam-valium/
[iv] Surapaneni H, Yalamanchili PS, Basha MH, Potluri S, Elisetti N, Kiran Kumar MV. Antibiotics in dental implants: A review of literature. J Pharm Bioallied Sci. 2016 Oct;8(Suppl 1):S28-S31. doi: 10.4103/0975-7406.191961. PMID: 27829741; PMCID: PMC5074034. [Accessed January 2024]
[v] Torof E, Morrissey H, Ball PA. Antibiotic Use in Dental Implant Procedures: A Systematic Review and Meta-Analysis. Medicina. 2023; 59(4):713. https://doi.org/10.3390/medicina59040713 [Accessed January 2024]
[vi] Gómez-Sandoval JR, Robles-Cervantes JA, Hernández-González SO, Espinel-Bermudez MC, Mariaud-Schmidt R, Martínez-Rodríguez V, Morgado-Castillo KC, Mercado-Sesma AR. Efficacy of clindamycin compared with amoxicillin-metronidazole after a 7-day regimen in the treatment of periodontitis in patients with diabetes: a randomized clinical trial. BMJ Open Diabetes Res Care. 2020 Jan;8(1):e000665. doi: 10.1136/bmjdrc-2019-000665. PMID: 31958293; PMCID: PMC6954743. [Accessed January 2024]
[vii] NHS England https://www.nhs.uk/medicines/metronidazole/
[viii] Dutta SR, Passi D, Singh P, Atri M, Mohan S, Sharma A. Risks and complications associated with dental implant failure: Critical update. Natl J Maxillofac Surg. 2020 Jan-Jun;11(1):14-19. doi: 10.4103/njms.NJMS_75_16. Epub 2020 Jun 18. PMID: 33041571; PMCID: PMC7518499. [Accessed January 2024]
[ix] Melini M, Forni A, Cavallin F, Parotto M, Zanette G. Analgesics for Dental Implants: A Systematic Review. Front Pharmacol. 2021 Jan 27;11:634963. doi: 10.3389/fphar.2020.634963. PMID: 33584316; PMCID: PMC7872962. [Accessed January 2024]
[x] Kim SJ, Seo JT. Selection of analgesics for the management of acute and postoperative dental pain: a mini-review. J Periodontal Implant Sci. 2020 Mar 19;50(2):68-73. doi: 10.5051/jpis.2020.50.2.68. PMID: 32395385; PMCID: PMC7192823. [Accessed January 2024]
[xi] Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent. 2020 Dec;103:103497. doi: 10.1016/j.jdent.2020.103497. Epub 2020 Oct 17. PMID: 33075450; PMCID: PMC7567658. [Accessed January 2024]
[xii] Raza FB, Vijayaragavalu S, Vaidyanathan AK. Bone Morphogenetic Protein as Bone Additive around Dental Implant and its Impact on Osseointegration: a Systematic Review. J Dent (Shiraz). 2022 Sep;23(2 Suppl):336-348. doi: 10.30476/DENTJODS.2021.90931.1536. PMID: 36588970; PMCID: PMC9789332. [Accessed January 2024]
[xiii] Mingarro-de-León A, Chaveli-López B, Gavaldá-Esteve C. Dental management of patients receiving anticoagulant and/or antiplatelet treatment. J Clin Exp Dent. 2014 Apr 1;6(2):e155-61. doi: 10.4317/jced.51215. PMID: 24790716; PMCID: PMC4002346. [Accessed January 2024]
