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 »  Home  »  Dental Implant 1  »  Pain and Dental Implantology: Sensory Quantification and Affective Aspects. Part I: At the Private Dental Office
Pain and Dental Implantology: Sensory Quantification and Affective Aspects. Part I: At the Private Dental Office

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Ernesto Muller, Dr Odont,
Director, Dental Implant Center, Universidad Santa Maria, School of Dentistry, Adjunct Professor of Periodontology and Oral Biology, Goldman School of Dental Medicine, Boston University, Boston, MA, USA.

Maria del Pilar Rios Calvo, Odont, MScD
Coordinator of Prosthetics, Dental Implant Center, Universidad Santa María, School of Dentistry, Private Practice limited to Prosthetic Dentistry, Centro Profesional Tamanaco, Caracas, Venezuela.

Approximately 3 years ago, 15 Venezuelan specialists in dental implantology gathered with the aim of answering the following question: How can one convince the patient who is afraid of experiencing pain during or after implant surgery, that placement of dental implants is not painful? After some pondering, several answers that could be given to the patient were expressed: The patient will be fine, because he will have received medication to prevent pain; This surgery is less painful than the extraction of a wisdom tooth; Before placement of the implants, a computerized T-scan will be taken to confirm the indication and the possibilities and to aid in the case presentation; It is just a matter of rapport between the dentist and the patient. They were also asked, based on their previous experience, whether any of the patients had complained about pain during or after the treatment. Each of the specialists indicated that all of their patients had been pleasantly surprised about how little pain and postoperative discomfort (or other symptoms) they had experienced.
Is there any scientific proof to lay the foundation to these answers? Based on previous studies, are there concrete conclusions indicating no major pain associated with dental implantology? Are we really prepared to answer this important ques tion: Does dental implantology cause pain?
A patient who comes to the dental office is concerned about the cost of treatment and longevity of the results of treatment, but the major concern is the fear of dental pain, which can increase when the patient becomes aware of the surgical procedures involved in the placement of dental implants. However, most of the answers that the clinicians give to the patient are based on thier own clinical experience. There is no clinical research reported (between 1987 and 2000) that directly addresses this topic. Until now, all of the answers that the clinicians have provided to the patient have been speculative. Because pain is an experience that cannot be shared, different individuals sensing identical noxious stimuli feel pain differently and react at different levels of suffering.
Dental-oral pain creates a physiological fear situation in which patients experience a sense of emergency and anxiety toward the dentist and the treatment. The primary motivating factors for accepting or rejecting dental implants as a restorative alternative therapy is based on previous dental experiences, the relationship between the patient and the dentist, and the personal threshold of pain. However, pain is now considered to be more than a sensation. It constitutes an experience that involves both sensation and emotion. Pain cannot be sensed in a detachable manner; it comes in combination with dislike, anxiety, fear, and urgency.
Pain is conceptualized as constituting an unpleasant sensory and emotional experience associated with actual or potential tissue damage. If the patient regards his experiences as pain it should be accepted as pain. The intensity of pain from physical injury relates to the attention given at the time to the pain. Pain does not become an issue until the consequences of the injury induce feelings of concern and anxiety that relate more to the therapy and recovery process than to the injury itself. Pain may be judged subjectively or objectively. Subjective evaluation is based on the patient’s description, whereas the objective evaluation is based on changes in vital signs. Because subjectivity in pain evaluation depends on the patients’ description at the onset, the clinician should fully understand pain intensity, temporal behavior, quality of sensation, and the painful sensation character as well as the differences between clinical versus experimental pain; acute versus chronic pain; somatic versus neurogenous pain; superficial versus deep somatic pain; primary versus secondary pain; musculoskeletal versus visceral pain; inflammatory versus noninflammatory pain; and stimulusevoked pain versus spontaneous pain.
The overall aim of this study was to assess pain
  1. during and after the placement of dental implants, and
  2. at the second-phase surgery.
Because the major fear of the patient is the pain felt during or after implant placement, this sensation of pain must be evaluated through a verbal method of reporting. The method must quantify the sensory and affective aspect of pain associated with dental implant surgical placement and the corresponding postoperative evolution of the case as well as the pain related to secondphase surgical procedures and the corresponding postoperative symptoms and sensations. This study included a 2-year follow up. This time frame was used to answer the constant concern of the patients in regards to the future possibility of losing an implant or having other types of complications that could lead to pain.