Pain and anxiety following the placement of dental implants

Int J Oral Maxillofac Implants. 2006 Nov-Dec;21(6):943-50.


Purpose: This study investigated pain experience and anxiety following dental implant placement using questionnaires and salivary cortisol measurements.

Materials and methods: Patients about to undergo implant placement were instructed to keep recovery diaries to assess pain experience (limitation of activities, postoperative symptoms) and to record average pain, worst pain, and interference with daily activities on a visual analog scale (VAS). To assess anxiety, patients completed the Spielberger self-evaluation questionnaire and collected salivary samples to measure cortisol levels. Saliva was collected 1 week before surgery, the day of surgery, and 3 and 6 days postoperatively. A repeated-measure analysis of variance was used to analyze pain and anxiety data.

Results: Eighteen patients (12 women and 6 men) who received 30 implants were recruited for the study. Following implant placement, most patients reported mild to moderate interference with daily activities and postoperative symptoms. No patient reported high levels of any symptom. Average pain experience decreased significantly with time (F = 6.17; P < .001), from a VAS score of 24/100 on day 1 to 12 on day 3 and 9 on day 6. Worst pain (F = 7.84; P < .001) and limitation of daily activities (F= 6.26; P < .001) were also highest on the first postoperative day; they also decreased to about half the maximum level by the second or third day. State anxiety, as evaluated by the Spielberger self-evaluation scale, was highest on the day of surgery. The salivary cortisol level did not validate this, as it did not differ with the time of collection (F = 2.22; P = .075).

Conclusions: Patient self-assessment indicates that implant placement is a mild to moderately painful and anxiety-provoking procedure. Some limitation of daily activities and symptoms are expected to occur, particularly during the first 3 postoperative days.

MeSH terms

  • Activities of Daily Living
  • Adult
  • Anxiety / etiology*
  • Anxiety / psychology
  • Dental Implants* / adverse effects
  • Dental Implants* / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrocortisone / analysis
  • Male
  • Medical Records
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / etiology*
  • Pain, Postoperative / psychology
  • Quality of Life
  • Recovery of Function / physiology
  • Saliva / chemistry
  • Surveys and Questionnaires
  • Time Factors


  • Dental Implants
  • Hydrocortisone