Purpose: Dental implant placement is often followed by acute pain, which is one of the most important patient-centered matters of treatment. However, this pain is often not adequately appreciated by clinicians, and knowledge about risk factors associated with acute pain is scant. An understanding of these factors is important to help clinicians deliver efficient pain control advice based on individual demand.

Materials and methods: A systematic review of the literature was carried out to identify published risk factors for acute pain after dental implant surgery. PubMed, Cochrane Central Register of Controlled Trials, Embase, and Google Scholar databases were searched to find pertinent studies up to August 2019. Cohorts and randomized controlled trials (RCTs; including split-mouth trials) were included. The criteria used were those described in the PRISMA statement for performing systematic reviews.

Results: Nine hundred twenty-five papers were identified through the initial searching. After three stages of screening, 38 articles were included in the qualitative analysis but only 8 in the quantitative analysis. Despite the heterogeneity of the included articles, these data showed that flapped (vs flapless) surgery, anxiety, longer surgical duration, anticipation of more pain before surgery, and higher pain levels at earlier time points play a key role in the intensity of acute pain after dental implant surgery. There is strong evidence to suggest that the place of insertion (maxilla/mandible) is not a risk factor for pain.

Conclusion: The results for the effect of immediate loading (vs delayed loading), number of implants inserted, sex, age, and smoking on pain were inconclusive.