Pakistan Journal of Pharmaceutical Sciences

Abstract: This study systematically compared the efficacy of four nonsteroidal anti-inflammatory drugs (NSAIDs) including a placebo, ibuprofen, diclofenac potassium, and rofecoxib-in managing postoperative pain and their impact on osseointegration following orthodontic micro implant surgery. Pain was quantified using the visual analog score (VAS) method, while osseointegration was assessed through laboratory examinations, bone morphogenetic protein-2 (BMP-2) secretion and cell proliferation rates. We collected and analyzed data on patients' pain scores, medication usage, and bone healing indicators to inform clinical decisions and enhance treatment outcomes. The ibuprofen group showed consistent and significant pain reduction in both non-occlusal and occlusal states, with a pain index decrease to 3.1±0.9 in the non-occlusal state and 3.8±1.3 in the occlusal state by the fifth postoperative day. The ibuprofen group also exhibited peak cell proliferation (246% at 48 hours post-implantation), surpassing the diclofenac potassium (180%) and rofecoxib (158%) groups, indicating its pronounced effect on osteoblast proliferation. Additionally, ibuprofen led to higher BMP-2 secretion (2.71?g/L at 24 hours) compared to diclofenac potassium (2.25?g/L) and rofecoxib (1.62?g/L), underscoring its role in BMP-2 secretion by osteoblasts. The ibuprofen group achieved the highest scores in occlusal function, aesthetics, masticatory function and satisfaction with orthodontic treatment. The study establishes a rationale for drug selection in pain management and osseointegration post-orthodontic micro implant surgery, affirming the short-term safety and efficacy of NSAIDs in orthodontic procedures.