The role of antibiotics in preventing healing complications after traumatic dental injuries: a literature review

Abstract

Traumatic dental injuries result in tissue damage and risk of infection. Experimental studies have shown various avenues for bacterial invasion following trauma: enamel infractions, dentinal tubules, exposed pulps, damaged periodontal ligament (PDL) and exposed alveolar bone. Hematogenous seeding of bacteria (anachoresis) may also occur during pulpal revascularization after trauma. The implication of these routes of entry differs according to the type of traumatic dental injury. It is known that bacterial colonization in a wound may protract or even arrest healing. Hence, it might be of interest to examine the possibility of protecting the healing events by the use of antibiotics after dental and maxillofacial trauma. A survey of the literature revealed a series of studies using an extraction/replantation model in monkeys and dogs. In periodontal ligament healing, these studies showed that systemically administered antibiotics (penicillin, streptomycin, amoxicillin and tetracycline) or topically applied antibiotics either on the root surface or in the root canal in general had the effect of preventing or reducing the extent of infection‐related resorption. With respect to pulpal healing, systemically administered antibiotics had no effect upon pulp healing whereas topically administered tetracycline (5 min storage in a tetracycline solution or the use of tetracycline powder) doubled the chance of pulp revascularization. To date, there has been only one non‐randomized clinical replantation study which showed that systemically applied penicillin did not reduce root resorption or the chance of pulp revascularization. In experimental studies, the topical use of tetracycline appeared to significantly improve the chance of revascularization of the pulp after replantation. In other dental trauma types, only a few clinical studies were available concerning the role of antibiotics and none of them were randomized. No positive effect of antibiotics has been reported on pulpal healing in cases of luxation injury or root fracture. Regarding PDL healing, a possible negative effect of antibiotics was indicated for lateral luxations; however, confounding factors might exist. In the case of mandibular fractures with communication to the oral cavity, five randomized studies were found, all indicating that antibiotics significantly reduced the risk of fracture line infection. Randomized clinical studies on the effect of systemic and topical use of antibiotics for traumatic dental injuries are very much needed.

Predictors for healing complications in the permanent dentition after dental trauma

“…The revascularization process may be arrested at any level in the root canal if bacteria gain access to the ischemic part of the pulp. This scenario is discussed elsewhere (4).…”

“…Other factors related to the risk of root resorption appear to be the presence of bacteria in the PDL (33), in the dentinal tubules or in the pulp, and the quality of endodontic treatment provided (34). These factors are discussed elsewhere (4). A relationship between the risk of root resorption complications and the tooth's stage of root development and the patient's age has been shown to exist as increasing age and root maturation adversely affect the risk of root resorption (1).…”

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

“…Antibiotics (67)(68)(69)(70)(71)(72)(73)(74)(75)(76) The value of systemic administration of antibiotics in human after replantation is still questionable as clinical studies have not demonstrated its value. Experimental studies have, however, usually shown positive effects upon both periodontal and pulpal healing especially when administered topically.…”

Dental Trauma Guide: A source of evidence‐based treatment guidelines for dental trauma

“…The results must, however, be evaluated with a certain amount of reservation as the risk of interference by confounding factors can never be eliminated with certainty. This type of analysis has so far offered useful information about the effect of various treatment procedures such as repositioning, type and length of splinting times (9, 10) and the use of antibiotics (11).…”