Comparison of the Postoperative Effects of Local Antibiotic versus Systemic Antibiotic with the Use of Platelet-Rich Fibrin on Impacted Mandibular Third Molar Surgery: A Randomized Split-Mouth Study

Abstract

The surgery of the impacted mandibular third molar is the most frequent procedure in dentistry. The prescription of systemic antibiotics after the third molar extraction is widespread among dentists, but this is still argumentative. This study is aimed at evaluating the postoperative effects of local antibiotic mixed with platelet-rich fibrin (PRF) and a postoperative systemic antibiotic prescribed for mandibular third molar surgery. The study included 75 patients divided into a control and 4 test groups ( n = 15 ). In the control group, only PRF was placed into the extracted socket, and no antibiotic was prescribed. In the first and third groups, PRF was applied to the socket; penicillin and clindamycin were prescribed as oral medications, respectively. In the second and fourth groups, only PRF combined with penicillin and clindamycin was applied into the socket, respectively. The outcome variables were pain, swelling, analgesic intake, and trismus. These variables were also assessed based on the first, second, third, and seventh days following the operation. Unpaired Student’s t -test and Mann–Whitney U test were used for analysis. There were significant differences in the total VAS pain scores between the control and group 3 ( p < 0.05 ), groups 1 and 2 ( p < 0.01 ), and group 4 ( p < 0.001 ) in ascending order. For analgesic intake, there was no significant difference for group 1 ( p > 0.05 ). However, there were statistical differences between the control group and groups 2 and 3 ( p < 0.01 ) and group 4 ( p < 0.001 ). Trismus and swelling did not differ among the groups ( p > 0.05 ). This study showed that the effects of local and systemic antibiotics with the use of PRF reduced postoperative outcomes. Moreover, local antibiotics with PRF may be a viable method to avoid the possible side effects of systemic antibiotics.

Evaluation of advanced platelet-rich fibrin (PRF) as a bio-carrier for ampicillin/sulbactam

“…This antibiotic-loaded PRF showed a locally antimicrobial effect [ 20 ]. In several other studies, antibiotics were added to the blood sample either for or after centrifugation for PRF production [ 20 , 21 , 32 – 34 ]. To our best knowledge, our study reveals for the first time, that PRF is also a bio-carrier for ampicillin/sulbactam if patients previously received the antibiotic as part of the regimen to treat ONJ.…”

Use or abuse of antibiotics as prophylactic therapy in oral surgery: A systematic review

“…In the initial search strategy, 578 studies were identified. The first filtering by title and abstract resulted in 54 potential studies; of these, 21 studies were selected [7–27] after carrying out the extensive review (the second filter), which are shown in Figure 1.…”

“…The antibiotics most prescribed as prophylactic therapy were beta-lactams, which were indicated in 100% of the studies. [7–27] Of these, the penicillin group predominated with amoxicillin being the most indicated drug in 52.3% of the studies (n = 11). [7,8,10–12,14,16,18,21,25,27] Amoxicillin in conjunction with clavulanic acid had the next highest uptake in 33.3% of the studies (n = 7).…”

“…Of the 21 studies included in this review, [7–27] 5 support the use of antimicrobial therapy as an effective prophylactic treatment for oral surgery procedures, [8,10,13,20,27] and 16 studies mention that there is insufficient evidence to support the use of antibiotics as prophylactic therapy in patients who will undergo some type of oral surgery. [7,9,11–18,20–27]…”

“…[7,8,[10][11][12]14,16,18,21,25,27] Amoxicillin in conjunction with clavulanic acid had the next highest uptake in 33.3% of the studies (n = 7). [9,15,17,19,22,24,26] A lower percentage of studies were those that indicated the use of antibiotics in combination with metronidazole, sulbactam, cefazolin, and unspecified penicillins. The prevailing doses per day were 2 g, [7,8,[10][11][12]14,15,21,23,24] for a period of 5 days, [8,9,17,20,24] followed by for 1 hour before the procedure.…”