Perioperative Anti-inflammatory Drugs and Recovery after Periodontal Surgery: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: Periodontal disease is a multifactorial chronic inflammatory condition that progressively destroys the periodontal supportive tissues. While periodontal surgical therapy is a successful treatment for periodontal disease, patients often experience postoperative complications such as pain, swelling, and discomfort, which affect their quality of life. This systematic review evaluated the efficacy and safety of perioperative steroidal and nonsteroidal anti-inflammatory drugs (SAIDs and NSAIDs) on postoperative pain and swelling and rescue medication consumption in adults undergoing periodontal surgeries. METHODS: A protocol guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was followed. Multiple online databases were searched up to April 2025 for randomized clinical trials (RCTs) comparing perioperative SAIDs and NSAIDs after periodontal surgery. The primary outcome measure was postoperative pain, while the secondary outcome measures were swelling and rescue medication consumption using a random-effects model. The GRADE system assessed the quality of the evidence for each included study. RESULTS: Of 2,354 articles screened, 6 RCTs with 262 participants were included. Perioperative NSAIDs showed a statistically significant reduction in postoperative pain for the first 6 h postoperatively compared with perioperative SAIDs (mean difference [MD]: 1.00 to 2.23; 95% confidence interval [CI]: 0.21, 3.77). Perioperative SAIDs yielded a statistically significantly greater reduction in postoperative pain 48 h postoperatively than perioperative NSAIDs did (MD: -0.23, 95% CI: -0.31, -0.14). Perioperative SAIDs and NSAIDs had comparable outcomes in terms of postoperative swelling and rescue medication consumption. DISCUSSION: Perioperative NSAIDs may be more effective in reducing early postoperative pain while SAIDs might offer better longer-term pain management postoperatively after periodontal surgery. However, these findings should be viewed with caution because of the clinically insignificant differences and the evidence based on few studies, with moderate-to-low certainty of evidence, due to methodological biases and discrepancies in drugs used and regimens. Therefore, further optimized RCTs confirming the efficacy and safety of perioperative SAIDs and NSAIDs in periodontal surgical procedures are still needed.Knowledge Transfer Statement:This systematic review and analysis found moderate-to-low-certainty evidence and limitations in the studies assessing the effectiveness of perioperative anti-inflammatory drugs to improve postoperative recovery after periodontal surgical therapies. This emphasizes the need for individualized perioperative therapeutic protocols based on surgical complexity and the need for tension-free wound healing pending further high-quality trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.033 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.031 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".