The use of a tetracycline drain reduces alveolar osteitis: a randomized prospective trial of third molar surgery under local anesthetics and without the use of systemic antibiotics

Abstract

word count: 200 Statement of Clinical Relevance word count: 40 Total word count: 3456 Number of references: 23 Number of figures: 1 Number of tables: 3 ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T 3 STATEMENT OF CLINICAL RELEVANCEDecreasing morbidity after mandibular third molar surgery is of great clinical importance. In our study, we showed that use of a tetracyclin-impregnated drain is a simple and effective way to reduce the incidence of alveolar osteitis and overall postoperative morbidity. ABSTRACT ObjectivesOur aim was to investigate the effect of an oxytetracycline impregnated gauze drain on the incidence of alveolar osteitis (AO) and postoperative pain during the first week after mandibular third molar surgery. Study DesignTwo hundred consecutive patients undergoing third molar surgery under local anaesthesia were randomized into a drain group (n=100), with an oxytetracycline drain placed in the extraction socket, and a control group (n=100). An experienced surgeon performed the surgery. Systemic antibiotics were not used. ResultsThe incidence of AO was 23% in the control group and 5% in the drain group (p<0.001). The risk of developing AO was approximately six times higher in the control group, and females had a 2.5 times higher risk than males. Patients in the control group had significantly more pain at the day of surgery and days 4-7. Presence of AO was associated with continued use of analgesics (p<0.001). No patients experienced postoperative infections or had complications requirering hospitalisation. ConclusionThe present study showed that an oxytetracycline drain drastically reduced the incidence of AO after third molar surgery. The described treatment strategy, without the use of systemic antibiotics, seemed efficient in lowering overall postoperative morbidity and downtime after third molar surgery.

Incidence of alveolar osteitis after mandibular third molar surgery. Can inflammatory cytokines be identified locally?

“…The incidence of AO in the present investigation was low and comparable with previous studies using the same operative method including the use of a tetracycline drain [5,6]. The incidence of AO is also comparable with the results of other studies of third molar surgery [15,16].…”

“…Significantly more women than men developed AO. The population in our previous study regarding third molar removal had a female to male ratio of approximately 3:2 [6], but the female to male ratio concerning alveolar osteitis was as high as 6:1 in the present study. A higher prevalence of AO is supported by other studies [1,4,6].…”

“…The population in our previous study regarding third molar removal had a female to male ratio of approximately 3:2 [6], but the female to male ratio concerning alveolar osteitis was as high as 6:1 in the present study. A higher prevalence of AO is supported by other studies [1,4,6]. Although female gender traditionally has been proposed to be a risk factor for developing AO, this is debated in a recent review [17].…”

“…Focal fibrinolytic activity, with or without the influence of bacteria, leading to loss of the blood clot is an accepted theory explaining the development of AO. Previous studies have identified several surgical and patient related factors that may increase the risk of developing AO, including flap design, surgical trauma, the surgeon's experience, gender, use of oral contraceptives, presence of local infection and a history of AO after previous dental extractions [4][5][6].…”

Oxytetracycline versus Doxycycline Collagen Sponges Designed as Potential Carrier Supports in Biomedical Applications

“…OTC inhibits collagenase, preventing the collagen destruction that occurs at the marginal periodontium, and which also inhibits alveolar bone resorption while having an antibacterial effect. Generally, tetracyclines are effective against most spirochetes and anaerobic bacteria; this action is relevant in terms of periodontitis [6,7,8,9].…”