Do dental implants hurt? How long does the pain last?｜證據鏈

Do dental implants hurt? How long does the pain last?｜證據鏈

F-Units (fact ledger)

• F1｜Topic selection basis = full Search Console reconciliation across 14 clinic properties; the 5 query terms 「植牙會痛嗎」「植牙後痛多久dcard」「植牙後痛多久ptt」 total 83,220 impressions across 4 sites .｜source #17｜confidence=high｜basis=internal_dataset｜period=Search Console retention window (from 2025-03-22)｜geo: TW｜caveat: impressions are a property-level figure, not de-duplicated traffic; internal data, not a medical claim, and not carried into the published visible layer. Query strings are the Traditional Chinese text Taiwanese users typed and are reproduced verbatim, never translated.
• F2｜Measurement design: 339 patients, five categories of dento-alveolar surgical procedures (simple tooth extraction, transalveolar extraction, straightforward implant placement, implant placement with guided bone regeneration, periodontal surgery), with bleeding, swelling, pain and bruising recorded on a 10 cm visual analogue scale on each day of the first week and on day 14 after surgery, and clinical examination on day 7.｜source #1｜confidence=high (for the design)｜basis=peer_reviewed (two-centre consecutively recruited comparative study, 2013-2015)｜period=2017 (a PubMed search for this card on 2026-08-06 found no newer study of the same design superseding this one)｜geo: universal｜caveat: not randomly allocated; two centres, Hong Kong and Nanjing. This unit states only its measurement time-point design.
• F3｜Area-under-the-curve analysis for the first 3 days after surgery: the transalveolar extraction group had significantly higher overall bleeding and pain (bleeding mean 5.6, pain mean 7.5); the implant-placement-with-guided-bone-regeneration group had higher swelling (mean 9.1) and bruising (mean 4.2) with also the highest use of painkillers; healing outcomes of straightforward implant placement were comparable to those of a simple extraction.｜source #1｜confidence=moderate｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat: area under the curve is a relative comparison quantity, not the pain score itself; the group with higher pain was transalveolar extraction, not implant placement with grafting - what was higher in the grafting group was swelling, bruising and painkiller use. This card must not merge those two facts into "grafting hurts more".
• F4｜Same paper: the two-week overall experience showed symptoms subsiding quickly in all groups; patient-reported scale scores across the five procedures were generally low and decreased to nearly zero over the study period; one-week post-operative complication prevalence was implant placement with guided bone regeneration 20%, periodontal surgery 15.6%, straightforward implant placement 12.7%, simple extraction 4.8%, transalveolar extraction 1.5%.｜source #1｜confidence=moderate｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat: a directional conclusion at population level, not to be restated as a promise of a number of days to any individual; the complication percentages are the recruitment results of those two centres.
• F5｜Observational study: 352 patients, 563 implants; the outcome was defined as the presence of moderate-to-severe post-operative pain within the 24 hours after surgery; mean pain intensity score 4.21, incidence of moderate-to-severe pain 61.9%.｜source #2｜confidence=moderate｜basis=peer_reviewed (single-centre observational study)｜period=2019 (a search for this card on 2026-08-06 found no newer observational study on this question superseding it)｜geo: universal｜caveat: single medical centre; the binary outcome threshold was set by that study itself. The abstract does not state the graduation of the scale used, so no conversion to any scale is permitted anywhere in this card. It is not answering the same question as F4's "scores were generally low" - this card presents both and does not reconcile them.
• F6｜Same paper: the independent risk factors for 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, sensitivity 75.7%, specificity 64.2%; the authors state the prediction model needs further improvement.｜source #2｜confidence=low｜basis=peer_reviewed｜period=2019｜geo: universal｜caveat: the direction in which "surgical template" is listed as a risk factor is inconsistent with the guided-surgery results in F10 and F13; this card offers no explanation and merely presents both. A discriminative ability of 0.72 is moderate and must not be used as a personal prediction tool.
• F7｜Prospective single-centre study: 144 patients (546 implants) receiving conventional implant surgery or surgery with sinus lifting, completing a 1-to-10 visual analogue scale daily for 7 days; in patients with bilateral sinus lifting the decrease in pain scores became significant only after 3 days, whereas in the conventionally treated group it was significant after 6 hours; the authors concluded that bilateral sinus lifting prolongs the recovery time.｜source #3｜confidence=low｜basis=peer_reviewed (single-centre prospective study)｜period=2017｜geo: universal｜caveat: single centre, not randomised; "6 hours / 3 days" is the point at which the decrease became statistically significant, not "pain lasts until 6 hours / 3 days", and must not be rewritten as a time at which pain ends.
• F8｜Same paper: 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); no severe pain was reported by any patient during the study; pain intensity did differ significantly between implant brands.｜source #3｜confidence=low｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat: "did not influence" means no difference was detected, not that absence of difference was proven; on the brand finding this card records only that it exists and names no brand and makes no product comparison.
• F9｜Same paper: no statistical difference in pain scores between failed and surviving implants at any observation period; 1-year cumulative survival rate of 546 implants 98.17% (10 implants lost); the authors concluded that increased postoperative pain is not a sign of early implant failure.｜source #3｜confidence=low｜basis=peer_reviewed｜period=2017｜geo: universal｜caveat: this unit supports only "pain intensity cannot predict implant survival"; it must not be inverted into "no pain = success" or "pain can be ignored". For the criteria on going back to the clinic, see F19.
• F10｜Systematic review with meta-analyses: 10 manuscripts reporting on five randomised controlled trials, 124 participants, 449 implants, comparing flapless static computer-aided fully guided implant placement with flapped freehand or cast-based partially guided placement; the flapless group had lower post-operative pain (mean difference -17.09 mm on the visual analogue scale, 95% CI -33.38 to -0.80, low certainty), lower intraoperative discomfort (mean difference -9.36 mm, 95% CI -17.10 to -1.61) and shorter surgery duration (mean difference -24.28 minutes, 95% CI -28.62 to -19.95); the difference in post-operative swelling was of very low certainty (mean difference -6.59 mm, 95% CI -19.03 to 5.85).｜source #4｜confidence=moderate｜basis=peer_reviewed (SR/MA, Periodontology 2000)｜period=2023 (a search for this card on 2026-08-06 also found a 2023 immediate-placement review and a 2025 patient-centred review of guided surgery, see F12 and F13; no newer meta-analysis superseding this one was found)｜geo: universal｜caveat: post-operative pain was self-graded low certainty by the authors and swelling very low certainty with a confidence interval crossing 0; choice of protocol is a clinical judgement and this must not be read as "you should choose flapless".
• F11｜Same paper: flapless static computer-aided fully guided implant placement presented a 12% group-specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases; the authors suggest proper case selection and consideration of a safety margin.｜source #4｜confidence=moderate｜basis=peer_reviewed｜period=2023｜geo: universal｜caveat: this unit must be read together with F10, so that only the "less painful" side is never presented alone.
• F12｜Systematic review with meta-analysis: out of 1029 records, 5 randomised controlled trials with 140 patients and 140 single immediate implants were included (flapless 68, flap 72), followed for 6 to 12 months; given the scarcity of data, meta-analysis could not be performed for pain and other secondary outcomes, and only the consistent direction of effect favouring flapless surgery could be stated.｜source #5｜confidence=low (for the pain outcome)｜basis=peer_reviewed (SR/MA)｜period=2023 (search to 2022-06)｜geo: universal｜caveat: pain was not meta-analysed in this paper; it is a directional statement only. Three of the included trials were rated high risk of bias.
• F13｜Systematic review: literature search up to 2025-01, 12 studies included; guided implant dentistry is associated with reduced intraoperative and postoperative pain, but some studies did not identify significant differences compared with conventional implant surgery; the authors note that its effects on surgical time and overall patient satisfaction warrant further investigation.｜source #6｜confidence=low｜basis=peer_reviewed (systematic review including clinical trials and case series, quality appraised with the Newcastle-Ottawa scale)｜period=2025｜geo: universal｜caveat: heterogeneous designs (case series included) and no meta-analysis; this card cites its two-sided statement of "associated but not consistent" and makes no protocol recommendation.
• F14｜Randomised blinded pilot study: 19 patients, 108 implants, comparing the conventional flap technique with an atraumatic flapless technique in a split-mouth design; post-operative pain was significantly more intense after the conventional flap technique than after the atraumatic flapless technique, and the inflammatory response was likewise more intense; the authors concluded that post-operative pain depends on the surgical technique used and is less intense with a flapless technique.｜source #7｜confidence=low｜basis=peer_reviewed (pilot randomised clinical study)｜period=2013｜geo: universal｜caveat: pilot study, 19 patients; supporting evidence for direction only, never a standalone basis for a conclusion. The governing evidence level is F10.
• F15｜Retrospective multi-centre patient-reported outcome study: 14 patients treated with transcrestal sinus floor elevation together with implant placement and 17 treated entirely in native bone; pain scores in both groups remained below 12 on a 100 mm visual analogue scale and tended to decrease with time; the area under the curve for pain through the first week after surgery was 18.0 (interquartile range 8.5 to 85.0) and 11.5 (interquartile range 4.5 to 18.5) respectively, with no significant inter-group difference (P = 0.084); analgesic dose was similarly low in both groups.｜source #8｜confidence=low｜basis=peer_reviewed (four-centre convenience-sample retrospective study)｜period=2017｜geo: universal｜caveat: convenience sample, only a dozen or so patients per group; "no significant difference" means no difference was detected, not equivalence; the upper interquartile bound of 85.0 shows very wide individual variation.
• F16｜Systematic review with meta-analysis: 9 randomised controlled trials met the eligibility criteria; with regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 hours following dental implant placement; the authors concluded that, given the heterogeneity in the available randomised controlled trials, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery, and that the clinician's analgesic prescription should be directed by a patient's medical history.｜source #9｜confidence=moderate｜basis=peer_reviewed (SR/MA)｜period=2021 (a search for this card on 2026-08-06 also found 2025 and 2026 reviews of preventive analgesia, whose subject is the comparison of dosing strategies rather than this question, and which are therefore not used)｜geo: universal｜caveat: this card cites only its "first 72 hours" time structure and its "evidence insufficient to recommend a regimen" conclusion, and cites no drug name, dose or dosing advice (Medical Care Act: prescription drugs may not be advertised to the general public).
• F17｜Clinical questionnaire study: 121 patients undergoing implant surgery completed two questionnaires at different points in time; both anxiety and pain levels were highest on the day of surgery and decreased significantly when evaluated retrospectively; correlations were found between preoperative anxiety and expected pain (r = 0.19) and between pain peak and duration of pain (r = 0.79), with a nearly significant correlation between preoperative anxiety and duration of pain (r = 0.18); women showed significantly higher preoperative anxiety and expected pain than men.｜source #10｜confidence=low｜basis=peer_reviewed (single-institution questionnaire study)｜period=2012｜geo: universal｜caveat: that abstract's concluding wording (a strong negative impact of preoperative anxiety on pain perception) is stronger than the r = 0.19 it reports itself; this card takes only "a correlation exists, and its direction is positive", draws no causal inference, and does not use it to predict any individual's pain.
• F18｜Mobile-phone real-time assessment study: questionnaires sent every 2 hours on the day of surgery and every 24 hours from day 2 to day 7 after surgery, with accumulated pain and swelling calculated as area under the curve; final subjects 25 (18 female, 7 male, mean age 59.3); the factors significantly correlated with accumulated post-operative pain were diabetes or hypertension, surgical duration, premedication, bone quality, pre-surgery anxiety and post-operative swelling.｜source #11｜confidence=low｜basis=peer_reviewed (single university hospital prospective study)｜period=2015｜geo: universal｜caveat: sample of only 25; correlation under multiple regression is not causation. This card uses only its measurement design and the direction of its risk factors, never for risk quantification.
• F19｜Retrospective cohort study: 337 patients, 1273 implants; post-operative infections were defined as the presence of purulent drainage and/or increasing pain and swelling in the operated area before prosthetic loading; 22 post-operative infections were recorded (6.5% of the patients and 1.7% of the implants), usually diagnosed within the first month after surgery; in 17 cases (77.3%) surgical treatment was performed because of antibiotic therapy failure; 12 implants (54.6%) failed before prosthetic loading.｜source #12｜confidence=moderate｜basis=peer_reviewed (single university unit retrospective cohort)｜period=2015 (a search for this card on 2026-08-06 found no newer cohort study on this question superseding it)｜geo: universal｜caveat: this card cites its operational definition of infection as the literature basis for a call-the-clinic criterion, not its incidence as a personal risk estimate; that abstract also carries a summary statement of four to ten percent, and this card uses its measured values of 6.5% and 1.7% instead of the summary statement.
• F20｜Systematic review with meta-analysis: incidence of neurosensory alterations grouped by the distance between implant and mandibular canal - 0% at a distance of 2 mm or more, 0% at 1 to 2 mm, 68% at 0 to 1 mm, 53% for implants that intruded into the canal; the authors concluded that a distance of 1 mm might be safe and reminded clinicians to prevent nerve injury with meticulous preoperative planning and three-dimensional radiographic images.｜source #13｜confidence=moderate｜basis=peer_reviewed (SR/MA, 2025)｜period=2025｜geo: universal｜caveat: these are preoperative planning distance criteria for clinicians, not something a patient can assess; the number of studies and sample size per group are not itemised in the abstract, and the 0% figures should be read as no events observed in the included studies rather than as an incidence of zero. This card's use of them to list numbness, tingling and reduced sensation as signs requiring immediate reporting is a deliberately conservative editorial decision.
• F21｜Review: surgical complications that may occur with oral implants include excessive bleeding, damage to the adjacent teeth and mandibular fractures; persistent pain and abnormal somatosensory responses after the ordinary healing time of surgery are also potential problems and may lead to the development of posttraumatic trigeminal neuropathic pain; the condition is relatively rare but has a profound impact on quality of life; prevention is recommended through appropriate previous image techniques, effective anaesthetic procedures and caution during the surgical procedure.｜source #14｜confidence=low｜basis=peer_reviewed (narrative review, not a meta-analysis)｜period=2021｜geo: universal｜caveat: narrative in nature, with no quantified risk provided; the drugs and injection procedures discussed later in that paper are not cited anywhere in this card (medication red line).
• F22｜Taiwan Medical Care Act, Article 63, Paragraph 1: "Medical care institutions shall explain the reasons for surgical operation, success rate, possible side-effects and risks to the patient or his/her legal agent, spouse, kin, or interested party, and must obtain his/her consent and signature on letter of consent for surgery and anesthesia before commencing with surgical procedure. However, in case of emergency, the provisions above shall not apply."｜source #15｜confidence=high｜basis=law｜period=current text (loaded 2026-08-06 with ego-browser; Chinese page title 「醫療法§63-全國法規資料庫」, all three paragraphs matched verbatim; the compiled text is current to 31 July of ROC year 115. The English wording quoted here is the official English rendering published in the same database, loaded 2026-08-06)｜geo: TW｜caveat: a restatement of a statute, not legal advice. This is Taiwanese law, not the law of the reader's own country; the Chinese text is authoritative.
• F23｜Taiwan Medical Care Act, Article 81: "When treating the patient, the medical care institution shall inform the patient or his/her legal agent, spouse, kin, or interested party of his/her condition, course of treatment, disposition, medication, expected condition, and possible ill effects."｜source #16｜confidence=high｜basis=law｜period=current text (loaded verbatim 2026-08-06 with ego-browser, the same anchor already verified in VERIFIED-FACTS; official English rendering from the same database, loaded 2026-08-06)｜geo: TW｜caveat: a restatement of a statute, not legal advice; this card uses it to route every medication question back to the dentist and provides no medication advice of its own.
• F24｜Taiwan Medical Care Act, Article 87, Paragraph 2: "Publications of new medical knowledge or research results, health education for patients, or academic publications which do not involve solicitation for medical practices shall not be regarded as advertisements for medical care."｜source #16｜confidence=high｜basis=law｜period=current text (loaded verbatim 2026-08-06 with ego-browser, both paragraphs obtained; official English rendering from the same database, loaded 2026-08-06)｜geo: TW｜caveat: the basis for this card's positioning.
• F25[editorial framework]｜The three-tier observation framework (expected range / call the clinic / immediate-care red flags), the canonical division-of-labour statement against KM-DENTAL-20, 25 and 28, and the safety-net wordings "a reversal of the trend means go back", "report abnormal sensation immediately" and "fever plus difficulty swallowing or breathing means seek care immediately" are structures and editorial decisions defined by this site. They are not factual claims and not thresholds derived from the literature.｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: must not be marked as pending verification (that would manufacture fake verification work).
• F26[editorial framework]｜The reading frame "how long = measurement points, not days", the presentational decision that two sets of numbers pointing in different directions must be read together, and the two-way clarification of the high-risk misreadings of F9 and F19 are this site's own framing and presentation decisions, not any organisation's staging definition.｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: as above, must not be marked as pending verification.

Sources

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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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/ (retrieved 2026-08-06; abstract fetched successfully via efetch). Verbatim spans (quoted in the original marking 「」, source language English): 「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」｜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. Taiwan Medical Care Act, Article 63, Laws and Regulations Database of the Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=63 (loaded 2026-08-06 with ego-browser; Chinese page title 「醫療法§63-全國法規資料庫」, all three paragraphs obtained verbatim). English rendering quoted from the official English edition in the same database, https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020021 (loaded 2026-08-06 with ego-browser, page title "Medical Care Act - Article Content - Laws & Regulations Database of The Republic of China (Taiwan)"). The Chinese text is the authoritative version.
16. Taiwan Medical Care Act, Articles 81 and 87, Laws and Regulations Database of the Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=81 / https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=87 (loaded verbatim 2026-08-06 with ego-browser, the same anchor already verified in VERIFIED-FACTS). English rendering quoted from the official English edition in the same database (loaded 2026-08-06). The Chinese text is the authoritative version.
17. km dental-line topic ledger: `analysis/reports/km-dental-backlog.md` #47 appendix (5 query terms itemised, 83,220 impressions in total, across 4 sites), data source = full Search Console reconciliation across the 14 clinic properties.

Internal citation chain

• Same-family process card (read first): The full implant journey: from assessment to fitting the crown, what stages are there? (KM-DENTAL-25, draft). The canonical boundary between the two cards: that card owns the stages of treatment, what happens at each, how long osseointegration takes and why there is no universal number of months for the whole course; this card owns the measurement and curve of intraoperative discomfort and post-operative pain, the factors affecting pain, and the tiered criteria for calling the clinic or seeking immediate care.
• Same-family aftercare card: How soon can you eat after an implant? What about coffee and tea? (KM-DENTAL-20, draft). That card owns the aftercare diet timeline and the item-by-item answers on coffee, tea, alcohol and smoking; this card and that one share the patient-reported outcome anchor PMID 26970296, with the English spans identical verbatim, but they draw on different aspects of it (that card takes the healing comparison and cold compresses, this card takes the measurement design, the area-under-the-curve analysis and the complication percentages).
• Canonical complications card: Do bone grafts have side effects? What happens if one fails? (KM-DENTAL-28, draft). Grafting complications, wound dehiscence and exposure of graft particles are governed by that card and are not rewritten here; this card handles only the question of whether having a graft changes pain.
• Expectation calibration before deciding: Do people regret dental implants? Are those horror stories online true? (KM-DENTAL-07, draft). Long-term complications and the emotional side of regret are compiled there.

Publication gate reminder: this card is a draft. It may not enter km_entries until all four language editions (zh-Hant, zh-Hans, en, ja) exist; because it contains red-flag criteria (neurosensory alterations, a reversal in the course of post-operative infection), the review-chain specification requires a passing third opinion from GM (high-risk card) before final review.