Because dental implant post-surgical pain is mainly driven by inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (eg, Advil®, Motrin® IB) or naproxen sodium (Aleve®) are logical choices to address it. These drugs are highly efficacious, non-addicting, and generally well tolerated. Dental implant patients, however, are generally older than those having their impacted third molars removed and are, therefore, likely to present with more comorbidities and drug intake, leading to potentially more adverse effects and serious adverse drug interactions.
Fortunately, pain following dental implant surgery is generally milder than that of impacted third molar surgery and is amenable to low over-the-counter (OTC) dosing regimens. Administering NSAIDs immediately after surgery before the local anesthesia has worn off and then around the clock for 2 to 3 days appears to be an effective strategy at not only preventing the onset of postoperative pain, but also diminishing breakthrough pain, which is typically seen with as-needed (PRN) dosing. Implant surgeons must be able to identify those patients in whom a short course of NSAIDs can be used safely and employ dosing strategies that provide optimal analgesic efficacy while limiting untoward events.
This article discusses current recommendations for postoperative pain management in dental implant patients, emphasizing the role of NSAIDs while addressing patient-specific safety considerations.
A Growing Market
The surgical placement of dental implants has become the gold standard for replacing missing teeth due to their high level of predictability and patient acceptance, with long-term success rates exceeding 95%.1 In fact, the global dental implant market is projected to grow from $7.7 billion in 2025 to $12.6 billion by 2032, with the United States making up 37% of this share.2
The soft-tissue and bony trauma associated with dental implant surgery upregulates inflammatory mediators, leading to postoperative pain that can persist for several days.3-5 Clinical practice guidelines recommend the prescribing of optimal doses of NSAIDs as first-line analgesic therapy for acute dental pain, unless contraindicated.6 Although these guidelines were largely based on trials conducted in young healthy adults following the removal of impacted third molars, evidence also supports the safety and efficacy of NSAIDs in managing post-surgical pain following dental implant implacement.3,7 Dental implant patients, as noted above, generally experience milder postoperative pain than dental impaction surgery patients. Thus, relatively low, OTC doses of NSAIDs initiated immediately after surgery, followed by around the clock dosing for several days, effectively prevent pain onset and reduce breakthrough pain in the early post-surgical period when pain is typically most intense.3
Effective Strategy
In a randomized, double-blind study of patients who had one or two implants surgically placed, naproxen sodium was more effective than acetaminophen in reducing pain intensity for the first 6 hours of the study when both were administered immediately after surgery completion (Figure 1).3 During this inpatient period, patients treated with acetaminophen reported significantly greater maximum pain scores (median = 3; interquartile range = 2 through 7) compared to patients who received naproxen sodium (median = 1; interquartile range = 0 through 2; P < .01).3 During subsequent outpatient OTC dosing over 3 days, the pain intensity recorded by patients in the naproxen sodium group remained significantly lower than in the acetaminophen group (Figure 2). These lower pain intensity scores for naproxen sodium directly correlated with its ability to lower concentrations of key inflammatory mediators.3 This study demonstrated that in non-complex dental implant cases, OTC dosing with an NSAID prior to the onset of post-surgical pain followed by around-the-clock dosing for up to 72 hours is a very effective strategy for pain management.
Consider the Patient
Dental implant patients, however, are generally older with more comorbidities and concomitant medications than dental impaction patients, resulting in a greater concern for adverse events and serious drug interactions.3,8 Despite their favorable safety profile at OTC doses, NSAIDs are not without risk, and their use remains associated with gastrointestinal (GI), renal, and cardiovascular adverse effects. The American Geriatric Society cautions against the use of non-selective NSAIDs in patients aged 65 years and older due to the increased risk of bleeding, GI ulcer, and acute kidney injury.9 NSAIDs can also raise blood pressure and blunt the antihypertensive effect of certain blood pressure lowering drugs, although this effect seems to be variable.8 This risk is greater in older patients and those with underlying renal insufficiency, but significant elevations in blood pressure have been reported in some normotensive individuals ingesting naproxen 500 mg/day after 1 week of dosing.10 Additional drug–drug and drug–disease interactions are described in Table 1 and Table 2, respectively.
For patients in whom NSAIDs are contraindicated, acetaminophen at the full therapeutic dose (ie, 650 to 1,000 mg every 6 to 8 hours) is recommended for pain management.6 Although acetaminophen was less effective than naproxen sodium in managing pain after placement of one to two dental implants, 66.7% of patients in the acetaminophen group rated the treatment as mostly or completely effective, and 93.3% rated it as good, very good, or excellent.3
Evidence-Based Approaches
Current evidence supports the use of NSAID-based analgesia following dental implant placement, but further research is needed to optimize pain management. Additional double-blind studies are needed that also evaluate ibuprofen/acetaminophen combinations in patients undergoing more complex implant surgery; such combinations have performed exceedingly well in patients undergoing the surgical removal of impacted third molars.5,11 The effectiveness of adjunctive herbal and non-pharmacologic interventions should also be further explored to define their role in pain management.12,13 Such studies could help inform evidence-based approaches to improve patient outcomes while minimizing medication-related risks.
About the Authors
Elliot V. Hersh, DMD, MS, PhD
Professor, Pharmacology and Oral Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
Paul A. Moore, DMD, PhD, MPH
Professor Emeritus, Dental Anesthesiology and Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
Katherine N. Theken, PharmD, PhD
Assistant Professor, Pharmacology and Oral Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
References
1. Ali K, Kay EJ. What are the long-term survival and complication rates of complete-arch fixed implant rehabilitation in edentulous patients? Evid Based Dent. 2019;20(3): 97-98.
2. DrBicuspid.com staff writers. Dental implants market projected to reach $12.6B. DrBicuspid.com. May 22, 2026. https://www.drbicuspid.com/dental-business/industry-updates/article/15825532/dental-implants-market-projected-to-reach-126b. Accessed July 7, 2026.
3. Theken KN, Chen M, Wall DL, et al. A randomized, double-blind pilot study of analgesic and anti-inflammatory effects of naproxen sodium and acetaminophen following dental implant placement surgery. Front Pharmacol. 2023;14:1199580.
4. Hashem AA, Claffey NM, O’Connell B. Pain and anxiety following the placement of dental implants. Int J Oral Maxillofac Implants. 2006;21(6):943-950.
5. Dionne RA, Neshat KJ. Safe, effective pain management following dental implant surgery. Compend Contin Educ Dent. 2026;47(5):246-248.
6. Carrasco-Labra A, Polk DE, Urquhart O, et al. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: a report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania. J Am Dent Assoc. 2024;155(2):102-117.e9.
7. Melini M, Forni A, Cavallin F, et al. Analgesics for dental implants: a systematic review. Front Pharmacol. 2021;11:634963.
8. Hersh EV, Pinto A, Moore PA. Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin Ther. 2007;29 suppl:2477-2497.
9. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
10. Theken KN, Ghosh S, Skarke C, et al. Degree of cyclooxygenase-2 inhibition modulates blood pressure response. Hypertension. 2026;83(2):e25516.
11. Hersh EV, Moore PA, Grosser T, et al. Nonsteroidal anti-inflammatory drugs and opioids in postsurgical dental pain. J Dent Res. 2020;99(7):777-786.
12. Iannitti T, Morales-Medina JC, Bellavite, P, et al. Effectiveness and safety of Arnica montana in post-surgical setting, pain and inflammation. Am J Ther. 2016;23(1):e184-e197.
13. Sourvanos D, Lander B, Sarmiento H, et al. Photobiomodulation in dental extraction therapy: postsurgical pain reduction and wound healing. J Am Dent Assoc. 2023;154(7):567-579.
Figures and Images
Figure 1
Figure 2
Table 1
Table 2
