Pain from Dental Implant Placement, Inflammatory Pulpitis Pain, and Neuropathic Pain Present Different Somatosensory Profiles

Aims: To address the two following questions: (1) What kind of somatosensory abnormalities may be characterized in patients receiving dental implants (IMP), in ongoing inflammatory dental pulpitis (IP) patients, and in neuropathic pain (atypical odontalgia [AO]) patients? and (2) What sort of sensory and neural changes may result from dental implant placement surgery and pulpectomy? Methods: A total of 60 subjects were divided into three groups: the IMP (n = 20), IP (n = 20), and AO groups (n = 20). Quantitative sensory testing (QST) was performed preoperatively (baseline) for all three groups and postoperatively at 1 month and 3 months after dental implant placement or pulpectomy (in the IMP group and IP group, respectively). Statistical analyses were completed with one-way and two-way analysis of variance and z score transformations (α = 5%). Results: The main findings of this study indicated that: (1) Elevations in mechanical detection threshold (MDT) and in current perception threshold (CPT) related to C-fiber activation, indicating a loss of function, were found at baseline in IP patients; (2) Somatosensory abnormalities such as allodynia, reduced MDT and mechanical pain threshold (MPT), and impaired pain modulation were found in AO patients; (3) No somatosensory alterations after implant placement were found in the IMP group; and (4) Somatosensory alterations in the form of reduction in the CPT related to C-fiber activation were reported 3 months after pulpectomy in the IP group. Conclusion: This study showed that somatosensory abnormalities were evident in AO and IP patients, and somatosensory alterations were seen in IP patients even 3 months after pulpectomy. However, no somatosensory alterations were seen after implant placement.

dental implants; dental pulp diseases; neuropathic pain; somatic pain; somatosensory disorders

1. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115–121.

2. Okeson JP. Bell`s Orofacial Pains: The Clinical Management of Orofacial Pain, ed 6. Chicago: Quintessence, 2005.

3. Rocha AP, Kraychete DC, Lemonica L, et al. Pain: Current aspects on peripheral and central sensitization. Rev Bras Anestesiol 2007;57:94–105.

4. Carver A, Foley F. Management of cancer pain. In: Kufe DW, Holland JF, Frei E III, American Cancer Society (eds). Cancer medicine 6. Lewiston, New York: BC Decker, 2003.

5. de Leeuw R (ed). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. American Academy of Orofacial Pain, ed 4. Chicago: Quintessence, 2008.

6. Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Conti PC. Effect of topical anaesthesia in patients with persistent dentoalveolar pain disorders: A quantitative sensory testing evaluation. Arch Oral Biol 2015;60:973–981.

7. Gaul C, Ettlin D, Pfau DB. [Persistent idiopathic facial pain and atypical odontalgia] [in German]. Z Evid Fortbild Qual Gesundhwes 2013;107:309–313.

8. Nixdorf DR, Drangsholt MT, Ettlin DA. Classifying orofacial pains: A new proposal of taxonomy based on ontology. J Oral Rehabil 2012;39:161–169.

9. Vickers ER, Cousins MJ, Walker S, Chisholm K. Analysis of 50 patients with atypical odontalgia. A preliminary report on pharmacological procedures for diagnosis and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:24–32.

10. Baad-Hansen L. Atypical odontalgia - pathophysiology and clinical management. J Oral Rehabil 2008;35:1–11.

11. Cruccu G, Anand P, Attal N. EFNS guidelines on neuropathic pain assessment. Eur J Neurol 2004,11:153–162.

12. Svensson P, Baad-Hansen L, Pigg M. Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions-a taskforce report. J Oral Rehabil 2011,38:366–394.

13. Rolke R, Baron R, Maier C. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. Pain 2006;123:231–243.

14. Abd-Elmeguid A, Yu DC. Dental pulp neurophysiology: Part

1. Clinical and diagnostic implications. J Can Dent Assoc 2009;75:55–59.

15. Zagury JG, Eliav E, Heir GM. Prolonged gingival cold allodynia: A novel finding in patients with atypical odontalgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:312–319.

16. Babbush CA. Dental Implants: The Art and Science, ed 2. Maryland Heights, Missouri: Saunders/Elsevier, 2011.

17. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain 2011;152:2399–2404.

18. Pigg M, List T, Petersson K, Lindh C, Petersson A. Diagnostic yield of conventional radiographic and cone-beam computed tomographic images in patients with atypical odontalgia. Int Endod J 2011;44:1092–1101.

19. Lu S, Baad-Hansen L, List T, Zhang Z, Svensson P. Somatosensory profiling of intra-oral capsaicin and menthol in healthy subjects. Eur J Oral Sci 2013;121:29–35.

20. Levin S, Pearsall G, Ruderman RJ. Von Frey’s method of measuring pressure sensibility in the hand: An engineering analysis of the Weinstein-Semmes pressure aesthesiometer. J Hand Surg Am 1978;3:211–216.

21. Hansson P, Backonja M, Bouhassira D. Usefulness and limitations of quantitative sensory testing: Clinical and research application in neuropathic pain states. Pain 2007;129:256–259.

22. Meier ML, Widmayer S, Abazi J. The human brain response to dental pain relief. J Dent Res 2015;94:690–696.

23. Lee YS, Kho HS, Kim YK, Chung SC. Influence of topical capsaicin on facial sensitivity in response to experimental pain. J Oral Rehabil 2007;34:9–14.

24. Murina F, Bianco V, Radici G, Felice R, Signaroldi M. Electrodiagnostic functional sensory evaluation of patients with generalized vulvodynia: A pilot study. J Low Genit Tract Dis 2010;14:221–224.

25. Nogami K, Taniguchi S. Stellate Ganglion Block, compared with xenon light irradiation, is a more effective treatment of neurosensory deficits resulting from orthognathic surgery, as measured by current perception threshold. J Oral Maxillofac Surg 2015;73:1267–1274.

26. Masson EA, Boulton AJ. The Neurometer: Validation and comparison with conventional tests for diabetic neuropathy. Diabet Med 1991;8(spec no):S63–S66.

27. Brunelli C, Zecca E, Martini C, et al. Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain. Health Qual Life Outcomes 2010;8:42.

28. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9–19.

29. Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: A comprehensive protocol for clinical trials. Eur J Pain 2006;10:77–88.

30. Pigg M, Baad-Hansen L, Svensson P, Drangsholt M, List T. Reliability of intraoral quantitative sensory testing (QST). Pain 2010;148:220–226.

31. Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Conti PC, Svensson P. Quantitative methods for somatosensory evaluation in atypical odontalgia. Braz Oral Res 2015;29. pii: S1806–83242015000100400. doi: 10.1590/1807-3107BOR-2015.vol29.0020.

32. Ellies LG, Hawker PB. The prevalence of altered sensation associated with implant surgery. Int J Oral Maxillofac Implants 1993;8:674–679.

33. Shavit I, Juodzbalys G. Inferior alveolar nerve injuries following implant placement - importance of early diagnosis and treatment: A systematic review. J Oral Maxillofac Res 2014;5:e2.

34. Al-Sabbagh M, Okeson JP, Khalaf MW, Bhavsar I. Persistent pain and neurosensory disturbance after dental implant surgery: Pathophysiology, etiology, and diagnosis. Dent Clin North Am 2015;59:131–142.

35. Juhl GI, Jensen TS, Norholt SE, Svensson P. Central sensitization phenomena after third molar surgery: A quantitative sensory testing study. Eur J Pain 2008;12:116–127.

36. Nasri-Heir C, Khan J, Benoliel R. Altered pain modulation in patients with persistent postendodontic pain. Pain 2015;156: 2032–2041.

37. Baad-Hansen L, List T, Kaube H, Jensen TS, Svensson P. Blink reflexes in patients with atypical odontalgia and matched healthy controls. Exp Brain Res 2006;172:498–506.

38. Holland GR. Periapical neural changes after pulpectomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:726–734.

39. Närhi M, Virtanen A, Kuhta J, Huopaniemi T. Electrical stimulation of teeth with a pulp tester in the cat. Scand J Dent Res 1979;87:32–38.

40. Shimazaki T, Otsuka T, Akimoto S, Kubo KY, Sato S, Sasaguri

K. Comparison of brain activation via tooth stimulation. J Dent Res 2012;91:759–763.

41. Holland GR. Steroids reduce the periapical inflammatory and neural changes after pulpectomy. J Endod 1996;22:455–458.

42. O›Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen

L. Association between a composite score of pain sensitivity and clinical parameters in low-back pain. Clin J Pain 2014; 30:831–838.

43. American Association of Electrodiagnostic Medicine. Guidelines in electrodiagnostic medicine. Technology review: the Neurometer Current Perception Threshold (CPT). Muscle Nerve Suppl 1999;8:S247–S259.

44. Lv SL, Fang C, Hu J. Assessment of peripheral neuropathy using measurement of the current perception threshold with the neurometer in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract 2015;109:130–134.

45. Shen J, Wang HQ, Zhou CP, Liang BL. Magnetic resonance microneurography of rabbit sciatic nerve on a 1.5-T clinical MR system correlated with gross anatomy. Microsurgery 2008;28:32–36.

46. Ikeda H, Suda H. Sensory experiences in relation to pulpal nerve activation of human teeth in different age groups. Arch Oral Biol 2003;48:835–841.

47. Yang GJ, Cao Y, Zhang L, Qin XY, Xie QF. [Data of the quantitative orofacial somatosensory functions of healthy subjects and its influence factors analysis]. Beijing Da Xue Xue Bao 2015;47:521–528.