Oral Sedation with Midazolam or Alprazolam in Dental Implant Surgery

Minimal sedation should be considered as part of the pharmacological protocol for surgical dental implant, in which pacients may have an increased level of stress, interrupting the course of the surgery, among other possible events. Objective: The aim of this study was to evaluate the clinical efficacy and safety of alprazolam, compared to midazolam in reducing anxiety in surgical dental implants. Method: Fifty volunteers, ASA I or ASA II, with indication for placement of dental implants, were divided into two equal groups (n=25), treated with orally 0.5 mg alprazolam or 7.5 mg midazolam, orally, in random order and double blind. The efficacy of sedation was assessed by the operator, using a CGI (Clinical Global Impression) and the volunteers themselves, through a range of visual analogue scale (VAS) in three different times. The arterial blood pressure (BP), heart rate (HR) and arterial oxygen saturation (SpO₂) were monitored in different periods. Side effects and incidence of anterograde amnesia were investigated by verbal contact, 24 hours after surgery. Results: Both benzodiazepines decreased anxiety levels in a similar way, with no significant difference between the treatments (Mann-Whitney, p>0.05).  The drugs showed safety, because the physiological parameters evaluated (BP, HR and SpO₂) remained within the normal range (Kruskal-Wallis, p>0.05). Anterograde amnesia occurred in only three volunteers treated with midazolam and the sleepiness was reported by three patients in each group. Conclusion: These findings suggest that orally administered alprazolam 0.5 mg and midazolam 7.5 mg comparably reduce anxiety in ambulatory implantodontic surgery patients, with high therapeutic index of safety.