SA1 - Do Opioids Truly Prevent Pain Following Bilateral Sinus Augmentation Procedures?

Abstract: The opioid epidemic has claimed hundreds of thousands of lives and touched millions throughout the United States. (Lyle Cooper, Thompson et al 2020) Within the veteran community, up to 50% of those with chronic pain may be misusing opioids. (Vowles, Schmidt et al 2022) Among opioid medications prescribed by dentists in the Veterans Affairs (VA) health system, nearly one-third exceeded prescribing guidelines. (Suda, Evans et al 2022) Dental healthcare professionals treating these patients must, therefore, inform themselves about when, why, and how to prescribe opioid medications appropriately and according to guidelines. Set simultaneously against the backdrop of the opioid epidemic, dental rehabilitation, specifically with dental implants, has grown dramatically. (Elani, Starr et al 2018) In order to place dental implants, however, these devices require adequate bone height and width; in the posterior maxilla, tooth loss is associated with increased alveolar bone loss and pneumatization of the maxillary sinus. Accordingly, for implants to be placed in the atrophic maxilla, sinus augmentation procedures (SAPs) are often required prior to implant placement. The aim of this study was to evaluate the use of postoperative opioid medications in preventing “return for pain” appointments following bilateral maxillary sinus augmentation procedures.
The medical and dental records of all of the patients who underwent maxillary SAPs at the Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) in Philadelphia, PA, between January 1, 2012, and July 28, 2023, were reviewed. After removing records with insufficient data for analysis, 32 patients with an associated 34 distinct surgical interventions for bilateral sinus augmentations (70 surgical sites) were included in this study. Patient records were audited to document confounding variables (age, diabetic status, social history) and opioid use history. Data was extracted into a piloted Excel Spreadsheet and analyzed as summarized in Appendix 1.
The results of this study suggest that post-operative opioid prescriptions do not reduce the number of “return for pain” appointments following bilateral sinus augmentation procedures (SAPs). Patients who were prescribed opioids following surgery had 1.67 times the odds of returning to the dental clinic with the chief complaint of pain as compared to those were not prescribed post-operative opioid-containing medications; however, these results were not statistically significant (P = .56). The results of this study also suggest that there is no difference in the number of “return for pain” appointments following bilateral SAPs between lateral window and transalveolar approaches to SAPs. Patients who underwent bilateral SAPs where at least one side of the maxilla underwent a lateral window SAP had 3.71 times the odds of returning to the dental clinic with the chief complain of pain as compared to patients who underwent bilateral SAPs where both sides of the maxilla underwent transalveolar SAPs; however, these results were not statistically significant (P = .39).
The results of this study may corroborate the increasingly widely held belief that opioid prescriptions are not as beneficial for postoperative pain management in dental procedures as once thought. Despite the decade-long period of this retrospective study, relatively few bilateral sinus augmentation procedures were performed (34 total surgeries); thus, this study suffers from a small sample size – although, there are no other studies with as long of a review period evaluating the use of opioid prescriptions in the literature on sinus surgeries. Accordingly, future work ought to be conducted in this field with multiple collaborating centers to increase the certainty of the evidence. For now, careful consideration ought to be exercised when prescribing postoperative opioid-containing medications, especially among at-risk individuals, like the United States’ veteran population.
Appendix 1: Odds Ratio Contingency Tables