Perioperative Anti-inflammatory Drugs and Recovery after Periodontal Surgery: A Systematic Review and Meta-Analysis

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.