Clinical considerations of sedation in dental surgery: a systematic review

Abstract

Introduction: In dental surgical procedures such as dental implants, extractions, and dental repairs, the demand for sedation has increased in an attempt to improve surgical quality and patient comfort, especially for those requiring longer surgeries and experiencing anxiety. Objective: It was to analyze the key clinical considerations of sedation in dental procedures to improve surgical conditions and patient comfort. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from March to May 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found. A total of 18 articles were evaluated in full and 10 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. It was concluded that intranasal and sublingual midazolam significantly reduces anxiety levels during dental procedures in children. Pregabalin coadministered with dexamethasone demonstrated significant efficacy in controlling postoperative pain and anxiety, as well as sedative effects. Ketamine-propofol may be a better option due to reduced episodes of vomiting and nausea in patients and higher levels of dental surgeon satisfaction. High doses of remifentanil can be safely used in multiple dental surgeries on the same day. The use of diazepam, midazolam, and nitrous oxide as preoperative sedation techniques for anxious patients undergoing third molar extractions is effective in controlling anxiety, with little effect on vital signs and retrograde amnesia. Patients under sedation for dental procedures frequently experience obstructive apnea/hypopnea events