Effect of antibiotic prophylaxis for preventing infectious complications following impacted mandibular third molar surgery. A randomized controlled trial

Abstract

Background The objective of this study was to determine the effect of antibiotic prophylaxis in preventing postoperative infections after extraction of impacted mandibular third molars. Material and Methods A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patients were randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery and control (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was the need for rescue analgesia. Results 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis, 1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Difference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99, 𝘱=0.41) NNTB=26. Rescue analgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49 (95%CI 0.32-0.75, 𝘱<0.05) NNTB=3. Conclusions The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk of postoperative infections from impacted mandibular third molars extraction, when compared to placebo. Nevertheless, antibiotic prophylaxis was associated with a reduced need for rescue analgesia. Key words: Antibiotic prophylaxis, third molar, tooth extraction, impacted tooth, dry socket, surgical wound infection, oral surgery.

A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial

“…The last possibility of alveolar osteitis (dry socket) is related to the patient himself. After the surgical extraction, there are a number of patients who do not adhere to the post-operative instructions and do mouth rinses and frequent sputum, which causes the clot to be washed out and the surface of the extracted tooth bone is exposed [ 3 , 11 , 22 ].…”

“…Co-amoxiclav (Augmentin) is a combination of clavulanic acid and amoxicillin [ 2 , 10 , 13 ]. The addition of clavulanic acid broadens the antibacterial spectrum of amoxicillin to include the bacteria which produce beta lactamase enzyme [ 1 , 2 , 3 , 4 , 5 , 6 ]. The beta-lactamase enzymes deactivate antibiotics such as penicillin and amoxicillin by hydrolyzing the peptide bond of beta-lactam ring [ 1 , 2 , 3 ].…”

“…There are too many factors which can contribute to infection or dry socket after surgical extraction. The most important factor is the formation of necrotizing tissue at the site of surgical extraction [ 3 , 4 , 5 , 6 ]. Causes of necrosis include inadequate blood supply (as in infarcted tissue), bacterial infection, traumatic injury and hyperthermia) of the bone.…”

“…Causes of necrosis include inadequate blood supply (as in infarcted tissue), bacterial infection, traumatic injury and hyperthermia) of the bone. Since surgical extraction requires raising the flap and removing bone on the buccal side using a low- and high-speed drill, this implies trauma to adjacent tissues [ 1 , 2 , 3 , 4 , 5 , 6 ]. Failure to raise the mucoperiosteal flap well leads to its rupture [ 7 ].…”

“…Therefore, the rupture of the periosteum or its burning during the removal of the bone with the rotating surgical burs results in the formation of foci of periosteal necrosis [ 6 , 8 ]. These necrotic tissues are considered as blood-deprived and dehydrated areas, impeding the process of healthy granulation, and an easy target for bacteria to attack and multiply at the site of the surgical extraction [ 3 , 5 , 8 ]. Furthermore, surgical extractions are mostly carried out for grossly decayed teeth with apical lesions and abscesses.…”