植牙會痛嗎？痛多久？｜證據鏈

植牙會痛嗎？痛多久？｜證據鏈

F-Units（事實單元帳）

• F1｜本題選題依據＝14 診所站 GSC 全量對帳，「植牙會痛嗎」「植牙後痛多久dcard」「植牙後痛多久ptt」5 詞項合計曝光 83,220、跨 4 站。｜來源 #17｜confidence=high｜basis=internal_dataset｜period=GSC 保留窗（2025-03-22 起）｜geo: TW｜caveat：曝光為屬性級數字、非去重流量；內部數據，非醫學宣稱，不進發布可見層。
• F2｜量測設計：339 位病人、五類牙槽手術（單純拔牙、翻瓣拔牙、單純植體置入、植牙合併引導骨再生術、牙周手術），以 10 公分視覺類比量表於術後第 1 週每日與第 14 天記錄出血、腫脹、疼痛與瘀青，第 7 天做臨床檢查。｜來源 #1｜confidence=high（對設計）｜basis=peer_reviewed（兩中心連續收案比較性研究，2013–2015）｜period=2017（本卡 2026-08-06 於 PubMed 檢索未見取代本篇之同設計新版研究）｜geo: universal｜caveat：非隨機分派、香港與南京兩中心；本條僅陳述其測量時間點設計。
• F3｜術後前 3 天曲線下面積分析：翻瓣拔牙組的整體出血與疼痛較高（出血平均 5.6、疼痛平均 7.5）；植牙合併引導骨再生術組的腫脹（平均 9.1）與瘀青（平均 4.2）較高，止痛藥使用量亦最高；單純植體置入的癒合表現與單純拔牙相當。｜來源 #1｜confidence=moderate｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat：曲線下面積為相對比較量、非疼痛分數本身；「疼痛較高」的那一組是翻瓣拔牙而非植牙合併補骨，補骨組較高的是腫脹與瘀青與止痛藥用量——本卡不得把這兩件事混寫成「補骨比較痛」。
• F4｜同篇：兩週的整體經驗顯示各組症狀都很快消退；五類手術的各項病人自述量表分數整體偏低，並在研究期間降到接近零；術後一週併發症比例為植牙合併引導骨再生術 20%、牙周手術 15.6%、單純植體置入 12.7%、單純拔牙 4.8%、翻瓣拔牙 1.5%。｜來源 #1｜confidence=moderate｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat：族群層級的方向性結論，不得轉述為對個人的天數承諾；併發症比例為該兩中心之收案結果。
• F5｜觀察性研究：352 位病人、563 支植體；結果定義為術後 24 小時內是否出現中度至重度疼痛；平均疼痛強度 4.21 分，中度至重度疼痛發生率 61.9%。｜來源 #2｜confidence=moderate｜basis=peer_reviewed（單一中心觀察性研究）｜period=2019（本卡 2026-08-06 檢索未見取代本篇之同題新版觀察研究）｜geo: universal｜caveat：單一醫學中心、二分結果門檻由該研究自訂；與 F4「分數整體偏低」問的不是同一個問題，兩者本卡並陳、不收斂。
• F6｜同篇：中度至重度術後疼痛的獨立風險因子為翻瓣手術、手術導板、焦慮狀態與疼痛敏感度的交互作用、疼痛敏感度與疼痛預期的交互作用，以及植體長度與即拔即種的交互作用；接收者操作特徵曲線下面積 0.72，敏感度 75.7%、特異度 64.2%；作者寫明該預測模型仍需進一步改進。｜來源 #2｜confidence=low｜basis=peer_reviewed｜period=2019｜geo: universal｜caveat：「手術導板」被列為風險因子的方向與 F10／F13 的導引手術結果不一致，本卡不對此作解釋、僅並陳；模型判別力 0.72 屬中等，不得當成個人預測工具。
• F7｜前瞻性單中心研究：144 位病人（546 支植體）接受常規植牙或合併上顎竇提升，以 1 至 10 分視覺類比量表連續填寫 7 天；雙側上顎竇提升者的疼痛分數在術後 3 天後才出現顯著下降，常規治療組則在術後 6 小時後即顯著下降；作者結論為雙側上顎竇提升會延長恢復時間。｜來源 #3｜confidence=low｜basis=peer_reviewed（單一中心前瞻性研究）｜period=2017｜geo: universal｜caveat：單一中心、非隨機；「6 小時／3 天」是統計顯著下降的起點，不是「痛到 6 小時／3 天為止」，禁改寫成疼痛結束時間。
• F8｜同篇：植體長度與直徑、以及有無上顎竇提升，在任何時間點均未影響疼痛分數（P > 0.05）；研究期間未有病人回報重度疼痛；不同植體品牌之間的疼痛強度則有顯著差異。｜來源 #3｜confidence=low｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat：「未影響」為未測到差異、非證明無差異；品牌差異一項本卡僅記錄其存在，不指名任何品牌、不作產品比較。
• F9｜同篇：失敗與存活的植體在任何觀察時間點的疼痛分數均無統計差異；546 支植體 1 年累積存活率 98.17%（10 支失敗）；作者結論為術後疼痛增加不是早期植體失敗的徵象。｜來源 #3｜confidence=low｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat：這條只支持「疼痛強度無法預測植體存活」，不得反推「不痛＝成功」或「痛不用理」；回診判準見 F19。
• F10｜系統性回顧與統合分析：10 篇報告、5 篇隨機對照試驗、124 位受試者、449 支植體，比較不翻瓣的靜態電腦輔助全導引手術與翻瓣的傳統手術；不翻瓣組術後疼痛較低（平均差 -17.09 公釐視覺類比量表，95% 信賴區間 -33.38 至 -0.80，低確定性）、術中不適較低（平均差 -9.36 公釐，95% 信賴區間 -17.10 至 -1.61）、手術時間較短（平均差 -24.28 分鐘，95% 信賴區間 -28.62 至 -19.95）；術後腫脹的差異為極低確定性（平均差 -6.59 公釐，95% 信賴區間 -19.03 至 5.85）。｜來源 #4｜confidence=moderate｜basis=peer_reviewed（SR/MA，Periodontology 2000）｜period=2023（本卡 2026-08-06 檢索同題另見 2023 年即拔即種版與 2025 年導引手術病人面向回顧，見 F12／F13，未見取代本篇之新版統合分析）｜geo: universal｜caveat：術後疼痛一項作者自評低確定性、腫脹一項極低確定性且信賴區間跨 0；術式選擇為臨床判斷，不得讀成「應該選不翻瓣」。
• F11｜同篇：不翻瓣的靜態電腦輔助全導引手術有 12% 的組內術中併發症率，其中 7% 的情況無法以該術式完成植體置入；作者建議需適當的病例選擇與安全邊界考量。｜來源 #4｜confidence=moderate｜basis=peer_reviewed｜period=2023｜geo: universal｜caveat：本條與 F10 必須合讀，避免只呈現「較不痛」的一面。
• F12｜系統性回顧與統合分析：1029 筆紀錄中納入 5 篇隨機對照試驗、140 位病人、140 支單顆即拔即種植體（不翻瓣 68、翻瓣 72），追蹤 6 至 12 個月；因資料稀少，疼痛等次要結果無法進行統合分析，僅能陳述各研究的效果方向一致偏向不翻瓣。｜來源 #5｜confidence=low（對疼痛結果）｜basis=peer_reviewed（SR/MA）｜period=2023（檢索至 2022-06）｜geo: universal｜caveat：疼痛在本篇未進統合分析，僅為方向性敘述；3 篇納入試驗被評為高偏差風險。
• F13｜系統性回顧：檢索至 2025-01，納入 12 篇研究；導引式植牙與較低的術中及術後疼痛有關，但部分研究未測到與傳統植牙手術的顯著差異；作者指出其對手術時間與整體病人滿意度的影響仍待進一步研究。｜來源 #6｜confidence=low｜basis=peer_reviewed（系統性回顧，含臨床試驗與病例系列，以 Newcastle-Ottawa 量表評品質）｜period=2025｜geo: universal｜caveat：納入設計異質（含病例系列）、未做統合分析；本卡引用其「有關但不一致」的雙面陳述，不作術式推薦。
• F14｜隨機分盲先導研究：19 位病人、108 支植體，以分口設計比較傳統翻瓣與微創不翻瓣術式；傳統翻瓣組的術後疼痛顯著較不翻瓣組強烈，發炎反應亦較明顯；作者結論為術後疼痛取決於所用術式，不翻瓣者較不強烈。｜來源 #7｜confidence=low｜basis=peer_reviewed（先導性隨機臨床研究）｜period=2013｜geo: universal｜caveat：先導研究、樣本 19 人，僅作方向佐證，不得單獨作為結論依據；證據層級以 F10 為主。
• F15｜回溯性多中心病人自述結果研究：14 位經牙脊竇底提升合併植體置入與 17 位完全在自體骨內植牙的病人；兩組疼痛分數在 100 公釐視覺類比量表上均維持在 12 以下且隨時間下降；術後第 1 週的疼痛曲線下面積分別為 18.0（四分位距 8.5 至 85.0）與 11.5（四分位距 4.5 至 18.5），組間無顯著差異（P = 0.084）；止痛藥劑量兩組同樣偏低。｜來源 #8｜confidence=low｜basis=peer_reviewed（四中心便利樣本回溯研究）｜period=2017｜geo: universal｜caveat：便利樣本、每組僅十餘人；「無顯著差異」為未測到差異、非等效；四分位距上緣 85.0 顯示個別差異極大。
• F16｜系統性回顧與統合分析：9 篇隨機對照試驗符合納入條件；就止痛給藥時程而言，疼痛調控可能在植體置入後的前 72 小時最為關鍵；作者結論為在現有隨機對照試驗異質性的限制下，尚無足夠證據推薦植牙手術後的特定止痛方案，臨床端的止痛處方應依病人病史決定。｜來源 #9｜confidence=moderate｜basis=peer_reviewed（SR/MA）｜period=2021（本卡 2026-08-06 檢索另見 2025 與 2026 年之預防性止痛回顧，主題為給藥策略比較、非本題，故不入卡）｜geo: universal｜caveat：本卡僅引用其「前 72 小時」時間結構與「證據不足以推薦方案」兩點，不引用任何藥物名稱、劑量或給藥建議（醫療法：處方藥不得對大眾廣告）。
• F17｜臨床問卷研究：121 位接受植牙手術的病人，於不同時點填寫兩份問卷；焦慮與疼痛程度皆在手術當天最高，事後回溯評估時顯著下降；術前焦慮與預期疼痛相關（r = 0.19），疼痛高峰與疼痛持續時間相關（r = 0.79），術前焦慮與疼痛持續時間之相關接近顯著（r = 0.18）；女性的術前焦慮與預期疼痛顯著高於男性。｜來源 #10｜confidence=low｜basis=peer_reviewed（單一機構問卷研究）｜period=2012｜geo: universal｜caveat：該篇摘要結論用語（術前焦慮對疼痛知覺有強烈負面影響）強於其自報的 r = 0.19，本卡只取「有相關、方向為正」，不作因果推論，也不用於預測個人疼痛。
• F18｜手機即時回報研究：手術當天每 2 小時、術後第 2 至第 7 天每 24 小時發送問卷，以曲線下面積計算累積疼痛與腫脹；最終受試者 25 人（女 18、男 7，平均年齡 59.3 歲）；與累積術後疼痛顯著相關的因素為糖尿病或高血壓、手術時間、前置給藥、骨質、術前焦慮與術後腫脹。｜來源 #11｜confidence=low｜basis=peer_reviewed（單一大學醫院前瞻性研究）｜period=2015｜geo: universal｜caveat：樣本僅 25 人，多重回歸下的相關不等於因果；本卡僅用其測量設計與風險因素方向，不用於風險量化。
• F19｜回溯世代研究：337 位病人、1273 支植體；術後感染定義為在假牙負重前，手術區出現膿性分泌物和／或疼痛與腫脹加劇；記錄到 22 例術後感染（占病人 6.5%、占植體 1.7%），通常於術後第 1 個月內診斷；其中 17 例（77.3%）因藥物治療無效而接受手術處置；12 支植體（54.6%）於負重前失敗。｜來源 #12｜confidence=moderate｜basis=peer_reviewed（單一大學單位回溯世代）｜period=2015（本卡 2026-08-06 檢索未見取代本篇之同題新版世代研究）｜geo: universal｜caveat：本卡引用其「感染的操作型定義」作為回診判準的文獻依據，而非引用其發生率作為個人風險估計；該篇摘要另有「四至十%」的概括句，本卡採其實測值 6.5%／1.7%，不採概括句。
• F20｜系統性回顧與統合分析：依植體與下顎管的距離分組計算神經感覺異常發生率——距離大於等於 2 公釐者 0%、1 至 2 公釐者 0%、0 至 1 公釐者 68%、植體侵入下顎管者 53%；作者結論為距離 1 公釐可能是安全的，並提醒臨床端應以周密術前規劃與三維影像預防神經損傷。｜來源 #13｜confidence=moderate｜basis=peer_reviewed（SR/MA，2025）｜period=2025｜geo: universal｜caveat：此為臨床端的術前規劃距離判準，不是病人可自我評估的項目；各組研究數與樣本量於摘要未逐項揭露，0% 一項應理解為納入研究中未觀察到事件、非發生率為零；本卡據此把「麻木、刺痛、感覺遲鈍」列為需立即回報的徵象，屬保守取向的編輯決定。
• F21｜綜論：植牙手術可能出現的外科併發症包含過度出血、鄰牙損傷與下顎骨折；超過一般癒合時間仍持續的疼痛與異常體感反應亦為潛在問題，可能發展為創傷後三叉神經病變性疼痛；該狀況相對少見但對生活品質影響深遠；建議以適當的術前影像技術、有效的麻醉處置與手術過程中的謹慎來預防。｜來源 #14｜confidence=low｜basis=peer_reviewed（敘述性綜論，非統合分析）｜period=2021｜geo: universal｜caveat：綜論性質、未提供量化風險；該篇後段討論之藥物與注射處置本卡一律不引用（用藥紅線）。
• F22｜《醫療法》第 63 條第 1 項：醫療機構實施手術，應向病人或其法定代理人、配偶、親屬或關係人說明手術原因、手術成功率或可能發生之併發症及危險，並經其同意，簽具手術同意書及麻醉同意書，始得為之；但情況緊急者，不在此限。｜來源 #15｜confidence=high｜basis=law｜period=現行條文（2026-08-06 以 ego-browser 實載，頁面標題「醫療法§63-全國法規資料庫」，三項條文逐字對得上；法規整編資料截止日民國 115 年 07 月 31 日）｜geo: TW｜caveat：條文轉述，非法律意見。
• F23｜《醫療法》第 81 條：醫療機構診治病人時，應向病人或其法定代理人、配偶、親屬或關係人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。｜來源 #16｜confidence=high｜basis=law｜period=現行條文（2026-08-06 以 ego-browser 實載逐字，同 VERIFIED-FACTS 已驗錨）｜geo: TW｜caveat：條文轉述，非法律意見；本卡據此把所有用藥問題導回醫師，未提供任何用藥建議。
• F24｜《醫療法》第 87 條第 2 項：醫學新知或研究報告之發表、病人衛生教育、學術性刊物，未涉及招徠醫療業務者，不視為醫療廣告。｜來源 #16｜confidence=high｜basis=law｜period=現行條文（2026-08-06 以 ego-browser 實載逐字，兩項條文取得）｜geo: TW｜caveat：本卡定位依據。
• F25［結構性整理］｜三級觀察框架（預期範圍／該主動回診／立即就醫紅旗）、與 KM-DENTAL-20／25／28 的 canonical 分工聲明、以及「走勢反轉就回診」「感覺異常立刻回報」「發燒與吞嚥呼吸不順立即就醫」等保守取向的就醫安全網措辭，皆為本站編輯定義之結構與編輯決定，非事實宣稱、非文獻導出之閾值。｜confidence=n/a｜basis=editorial｜geo: TW｜caveat：不得標為待驗（避免製造假查證工作）。
• F26［結構性整理］｜「痛多久＝測量點而非天數」的閱讀框架、「兩組方向不同的數字必須併讀」的呈現決定，以及對 F9／F19 之高風險誤讀的雙向澄清寫法，皆為本站編輯定義的提問與呈現框架，非任何機構的分期定義。｜confidence=n/a｜basis=editorial｜geo: TW｜caveat：同上，不得標為待驗。

來源清單

1. Yao J, Lee KK, McGrath C, Wu YN, Li KY, Mattheos N. Comparison of patient-centered outcomes after routine implant placement, teeth extraction, and periodontal surgical procedures. Clin Oral Implants Res. 2017 Apr;28(4):373-380. PMID 26970296. https://pubmed.ncbi.nlm.nih.gov/26970296/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「POAs in terms of bleeding, swelling, pain, and bruising were obtained using 10 cm visual analog scale (VAS) on each day of the first week and the 14th day postsurgery」「For the first 3 days of healing, area-under-the-curve (AUC) analyses showed that transalveolar extraction (TE) resulted in significantly higher overall bleeding and pain (AUC: Bleeding Mean = 5.6, Pain Mean = 7.5)」「implant placement with GBR (IGBR) resulted in significant higher level of swelling (AUC: Mean = 9.1) and bruising (Mean = 4.2) for the same period with also the highest use of painkillers」「Healing outcomes of straightforward implant placement (I) were comparable to that of a simple extraction (SE)」「Two-week overall experience showed the symptoms quickly subsided for all groups」「Prevalence for complications 1 week postoperatively was IGBR (20%), P (15.6%), I (12.7%), SE (4.8%), TE (1.5%), respectively」「The VAS scores for all POAs parameters were generally low and decreased to nearly zero over the study period following all five surgical procedures」
2. Wang M, Li Y, Li J, Fan L, Yu H. The risk of moderate-to-severe post-operative pain following the placement of dental implants. J Oral Rehabil. 2019 Sep;46(9):836-844. PMID 31074878. https://pubmed.ncbi.nlm.nih.gov/31074878/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「A observational study of 352 patients with 563 implants was carried out」「The outcome was the presence of moderate-to-severe post-operative pain within the 24 hours post-surgery」「The mean pain intensity score was 4.21 within 24 hours post-operatively, while the incidence of moderate-to-severe pain was 61.9%」「Independent risk factors of moderate-to-severe post-operative pain were flap surgery, surgical template, the interaction between anxiety state and pain sensitivity, the interaction between pain sensitivity and pain expectation and the interaction between implant length and immediate implant」「The area under the receiver operator characteristic curve was 0.72. The model's sensitivity was 75.7%, and the specificity was 64.2%」「The risk factors and the prediction model (needs further improvement) can help dentists to identify patients at increased risk of moderate-to-severe post-operative pain following dental implantation」
3. Atalay B, Ramazanoglu M, Tozan EN, Ozyuvaci H. Pain intensity and its objective determinants following implant surgery and sinus lifting: A 1-year prospective study. Niger J Clin Pract. 2017 Sep;20(9):1139-1144. PMID 29072237. https://pubmed.ncbi.nlm.nih.gov/29072237/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「This prospective, single-center study consisted of 144 patients scheduled for the surgical placement of one or more implants either with conventional surgery or with sinus-lifting together」「All patients were asked to complete a questionnaire form of pain with a visual-analog scale (VAS, 1-10) for 7 days following surgery」「The overall cumulative survival rate of 546 implants in 144 patients was 98.17 % (10 implants lost) after 1-year follow-up. No statistical difference was found in pain (VAS) scores between patients with loss and survived implants at any observation period」「The length and diameter of placed implants and the presence of a sinus-lifting procedure did not influence the pain scores at any period (P > 0.05)」「In patients with bilateral sinus lifting, the decrease in pain scores was significant after 3 days (P < 0.05), whereas it was significant after 6 hours for the conventionally treated group (P < 0.01)」「Although no severe pain was reported at any time, this study found a significant difference in pain intensities among different implant brands」「This study was able to show that increased postoperative pain is not a sign of early implant failure」「the bilateral sinus lifting prolongs the recovery time」
4. Romandini M, Ruales-Carrera E, Sadilina S, Hämmerle CHF, Sanz M. Minimal invasiveness at dental implant placement: A systematic review with meta-analyses on flapless fully guided surgery. Periodontol 2000. 2023 Feb;91(1):89-112. PMID 35906928. https://pubmed.ncbi.nlm.nih.gov/35906928/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast-based partially guided implant placement (cPGIP), were included」「postoperative pain (MD = -17.09 mm on the visual analogue scale (VAS); 95% CI: -33.38 to -0.80; low certainty)」「postoperative swelling (MD = -6.59 mm on the VAS; 95% CI: -19.03 to 5.85; very low certainty), intraoperative discomfort (MD = -9.36 mm on the VAS; 95% CI: -17.10 to -1.61) and surgery duration (MD = -24.28 minutes; 95% CI: -28.62 to -19.95) in flapless sCAIP than in flapped FHIP/cPGIP」「flapless sCAIP presented a 12% group-specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases」「A proper case selection and consideration of a safety margin are, however, suggested」
5. Pitman J, Christiaens V, Callens J, Glibert M, Seyssens L, Blanco J, Cosyn J. Immediate implant placement with flap or flapless surgery: A systematic review and meta-analysis. J Clin Periodontol. 2023 Jun;50(6):755-764. PMID 36843361. https://pubmed.ncbi.nlm.nih.gov/36843361/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「Out of 1029 records, 5 RCTs were selected reporting on 140 patients who received 140 single immediate implants (flapless: 68; flap: 72)」「Risk of bias assessment yielded low risk for two RCTs and high risk for three RCTs」「Given the scarcity of data, meta-analyses could not be performed on other secondary outcomes. Available studies were consistent in the direction of the effect favouring flapless surgery for vertical buccal bone change as well as for pain」
6. García-Valdez D, Velasco-Ortega E, Ortiz-Garcia I, et al. Impact of Guided Implant Dentistry on Patient Quality of Life, Satisfaction, and Psychological Well-Being: A Systematic Review. J Clin Med. 2025 Sep 20;14(18):6638. PMID 41010842. https://pubmed.ncbi.nlm.nih.gov/41010842/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「A literature search was conducted in PubMed, Embase, and CINAHL up to January 2025」「A total of twelve studies were included」「It is associated with a reduced intraoperative and postoperative pain. Some studies, however, did not identify significant differences compared with conventional implant surgery」「Its effects on surgical time and overall patient satisfaction, however, warrant further investigation」
7. Parmigiani-Izquierdo JM, Sánchez-Pérez A, Cabaña-Muñoz ME. A pilot study of postoperative pain felt after two implant surgery techniques: a randomized blinded prospective clinical study. Int J Oral Maxillofac Implants. 2013 Sep-Oct;28(5):1305-10. PMID 24066322. https://pubmed.ncbi.nlm.nih.gov/24066322/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「One hundred eight implants were placed in 19 patients」「Postoperative pain was significantly more intense after surgery with the conventional flap technique than after surgery with the atraumatic flapless technique」「Postoperative pain depends on the surgical technique used and is less intense with a flapless technique」
8. Franceschetti G, Rizzi A, Minenna L, Pramstraller M, Trombelli L, Farina R. Patient-reported outcomes of implant placement performed concomitantly with transcrestal sinus floor elevation or entirely in native bone. Clin Oral Implants Res. 2017 Feb;28(2):156-162. PMID 26749535. https://pubmed.ncbi.nlm.nih.gov/26749535/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「A convenience sample of 14 patients and 17 patients (contributing with one implant site each) treated with tSFE and N, respectively, was obtained for this study」「VASpain remained low (<12) in both groups. A tendency of VASpain to decrease with time was observed in both groups」「indicating the level of pain experience through the first week following surgery, was 18.0 (IR: 8.5-85.0) and 11.5 (IR: 4.5-18.5) in tSFE and N groups, respectively, with no significant inter-group differences (P = 0.084)」「The dose of analgesics was similarly low between groups」
9. Khouly I, Braun RS, Ordway M, Alrajhi M, Fatima S, Kiran B, Veitz-Keenan A. Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig. 2021 May;25(5):2511-2536. PMID 33839939. https://pubmed.ncbi.nlm.nih.gov/33839939/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「Nine RCTs fulfilled the eligibility criteria」「With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement」「given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery」「the clinician's analgesic prescription should be directed by a patient's medical history」
10. Weisensee W, Scheer M, Müller L, Rothamel D, Kistler F, Bayer G, Jöhren P, Neugebauer J. Impact of anxiety parameters on prospective and experienced pain intensity in implant surgery. Implant Dent. 2012 Dec;21(6):502-6. PMID 23085688. https://pubmed.ncbi.nlm.nih.gov/23085688/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「One hundred twenty-one patients undergoing implant surgery evaluated their anxiety and pain levels by completing a set of 2 questionnaires at different points in time」「Both anxiety and pain levels were highest on the day of surgery and showed a significant decrease when evaluated retrospectively」「Correlations were found between preoperative anxiety and expected pain levels (r = 0.19), pain peak and duration of pain (r = 0.79), and a nearly significant correlation between preoperative anxiety and duration of pain (r = 0.18)」「Women showed significantly higher levels of preoperative anxiety (P < 0.05) and expected pain (P < 0.05) than men」
11. Kuroi R, Minakuchi H, Hara ES, Kawakami A, Maekawa K, Okada H, Kuboki T. A risk factor analysis of accumulated postoperative pain and swelling sensation after dental implant surgery using a cellular phone-based real-time assessment. J Prosthodont Res. 2015 Jul;59(3):194-8. PMID 26077378. https://pubmed.ncbi.nlm.nih.gov/26077378/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「Cellular phone-based questionnaire was sent at pre-set schedule to each subject every 2h on the day of surgery, and every 24h from the 2nd to 7th day post-surgery」「Final subjects were 18 females and 7 male」「Significant factors correlated with accumulated postoperative pain were DM/HT, surgical duration, premedication, bone quality, pre-surgery anxiety and postoperative swelling」「These results suggested DM/HT and bone quality are correlated to overall intensity of postoperative pain and swelling」
12. Camps-Font O, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C. Postoperative Infections After Dental Implant Placement: Prevalence, Clinical Features, and Treatment. Implant Dent. 2015 Dec;24(6):713-9. PMID 26384096. https://pubmed.ncbi.nlm.nih.gov/26384096/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「Postoperative infections were defined as the presence of purulent drainage and/or increasing pain and swelling in the operated area before prosthetic loading」「Three hundred thirty-seven participants (1273 implants) were included. Twenty-two postoperative infections were recorded (6.5% of the patients and 1.7% of the implants)」「These complications were usually diagnosed within the first month, and in 17 cases (77.3%) surgical treatment was performed because of antibiotic therapy failure」「Twelve implants (54.6%) in 12 patients (54.6%) failed before prosthetic loading」
13. Peña-Cardelles JF, Markovic J, Akhondi S, Pedrinaci I, Lanis A, Gallucci GO. Inferior alveolar nerve damage related to dental implant placement. A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2025 Jul 1;30(4):e578-e589. PMID 40192114. https://pubmed.ncbi.nlm.nih.gov/40192114/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「The incidence of neurosensory alterations in patients with implants placed at a distance ≥ 2 mm from the mandibular canal was 0%. Similarly, for distances between 1-2 mm from the mandibular canal, the incidence remained at 0%」「for implants placed at a distance of 0-1 mm from the mandibular canal, the incidence of neurosensory alterations was 68%. Additionally, patients with implants that intruded into the canal had an incidence of 53% in the development of neurosensorial alterations」「A distance of 1 mm from the mandibular canal might be safe」「Clinicians should be aware of the potential risk of nerve injury and adopt appropriate precautions, including meticulous preoperative planning and three-dimensional radiographic images」
14. Conti PCR, Bonjardim LR, Stuginski-Barbosa J, Costa YM, Svensson P. Pain complications of oral implants: Is that an issue? J Oral Rehabil. 2021 Feb;48(2):195-206. PMID 33047362. https://pubmed.ncbi.nlm.nih.gov/33047362/（取用 2026-08-06，efetch 摘要取回成功）。逐字 span：「surgical complications may occur, as excessive bleeding, damage to the adjacent teeth and mandibular fractures」「Persistent pain and abnormal somatosensory responses after the surgery ordinary healing time are also potential problems and may lead to the development of a condition named posttraumatic trigeminal neuropathic pain (PTNP)」「Though relatively rare, PTNP has a profound impact on patient's quality of life」「Appropriated previous image techniques, effective anaesthetic procedures and caution during the surgical procedure and implant installation are recommended for the prevention of this condition」
15. 《醫療法》第 63 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=63（2026-08-06 以 ego-browser 實載，頁面標題「醫療法§63-全國法規資料庫」，三項條文逐字取得）
16. 《醫療法》第 81、87 條，全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=81／https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=87（2026-08-06 以 ego-browser 實載逐字，同 VERIFIED-FACTS 已驗錨）
17. km 牙醫線選題底帳：`analysis/reports/km-dental-backlog.md` #47 附錄（5 詞項逐筆、合計 83,220、跨 4 站），資料源＝14 診所資產 GSC 全量對帳。

內部引用鏈

• 同族流程卡（先讀）：植牙全過程：從評估到裝上牙冠，會經歷哪幾關？（KM-DENTAL-25，草稿）。兩卡的 canonical 邊界：歸該卡的是——療程有哪幾關、每一關做什麼、骨整合要等多久、總療程為何沒有通用月數；歸本卡的是——術中不適與術後疼痛的量測與曲線、疼痛的影響因素、回診與立即就醫的分級判準。
• 同族術後卡：植牙後多久能吃東西？咖啡跟茶可以喝嗎？（KM-DENTAL-20，草稿）。該卡管術後飲食時間軸與咖啡、茶、酒精、吸菸的逐項答案；本卡與該卡共用 PMID 26970296 這條病人自述結果錨，英文 span 逐字一致，但取用面向不同（該卡取癒合比較與冰敷，本卡取測量設計、曲線下面積與併發症比例）。
• 併發症正典卡：補骨粉會有後遺症嗎？失敗了會怎樣？（KM-DENTAL-28，草稿）。補骨的併發症、傷口裂開與顆粒外露等紅旗以該卡為準，本卡不重寫；本卡只處理「有沒有補骨會不會改變疼痛」這一問。
• 決策前的期望校正：植牙會後悔嗎？網友的慘痛經驗是真的嗎？（KM-DENTAL-07，草稿）。長期併發症與後悔情緒的整理在該卡。

發布閘門提醒：本卡為 draft。四語（zh-Hans／en／ja）未產前不得進 km_entries；本卡含紅旗判準（神經感覺異常、術後感染走勢反轉），依審核鏈規格需 GM 第三意見（高風險卡）通過後才進終審。