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

Ceren Melahat Donmezer, Kani Bilginaylar, Ceren Melahat Donmezer, Kani Bilginaylar

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.

Conflict of interest statement

There are no conflicts of interest.

Copyright © 2021 Ceren Melahat Donmezer and Kani Bilginaylar.

Figures

Figure 1
Figure 1
The same osteotomy technique was performed to remove the buccal bone around the crown of the impacted tooth in all groups. No tooth sectioning was performed.
Figure 2
Figure 2
In all cases, PRF was placed gently without aspiration and the wound was immediately closed with 3-0 silk sutures.
Figure 3
Figure 3
Each 10 mL tube produced one PRF clot, which was adequate to fill one extracted socket.
Figure 4
Figure 4
In groups 2 and 4, 0.5 mL antibiotics were injected into the PRF using a 2.5 mL dental syringe.

References

    1. Bataineh A. B., Albashaireh Z. S., Hazza’a A. M. The surgical removal of mandibular third molars: a study in decision making. Quintessence International . 2002;33(8):613–617.
    1. Busa A., Parrini S., Chisci G., Pozzi T., Burgassi S., Capuano A. Local versus systemic antibiotics effectiveness: a comparative study of postoperative oral disability in lower third molar surgery. The Journal of Craniofacial Surgery . 2014;25(2):708–709. doi: 10.1097/SCS.0000000000000431.
    1. Osunde O. D., Adebola R. A., Omeje U. K. Management of inflammatory complications in third molar surgery: a review of the literature. American Health Sciences . 2011;11(3):530–537.
    1. Caymaz M. G., Uyanık L. O. Comparison of the effect of advanced platelet-rich fibrin and leukocyte- and platelet-rich fibrin on outcomes after removal of impacted mandibular third molar: a randomized split-mouth study. Nigerian Journal of Clinical Practice . 2019;22(4):546–552.
    1. Uyanık L. O., Bilginaylar K., Etikan İ. Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes. Head & Face Medicine . 2015;11(1):25–32. doi: 10.1186/s13005-015-0081-x.
    1. Poeschl P. W., Eckel D., Poeschl E. Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity? Journal of Oral and Maxillofacial Surgery . 2004;62(1):3–8. doi: 10.1016/j.joms.2003.05.004.
    1. Cervino G., Cicciù M., Biondi A., et al. Antibiotic prophylaxis on third molar extraction: systematic review of recent data. Antibiotics . 2019;8(2):p. 53. doi: 10.3390/antibiotics8020053.
    1. Xue P., Wang J., Wu B., Ma Y., Wu F., Hou R. Efficacy of antibiotic prophylaxis on postoperative inflammatory complications in Chinese patients having impacted mandibular third molars removed: a split- mouth, double-blind, self-controlled, clinical trial. British Journal of Oral and Maxillofacial Surgery . 2015;53(5):416–420. doi: 10.1016/j.bjoms.2015.02.001.
    1. Hussein R. J., Krohn R., Kaufmann-Kolle P., Willms G. Qualitatsindikatoren fur die Anwendung systemischer Antibiotika in der Zahnheilkunde. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen . 2017;122:1–8. doi: 10.1016/j.zefq.2017.04.007.
    1. Kreutzer K., Storck K., Weitz J. Current evidence regarding prophylactic antibiotics in head and neck and maxillofacial surgery. BioMed Research International . 2014;2104:7.
    1. Singh A., Kohli M., Gupta N. Platelet rich fibrin: a novel approach for Osseous regeneration. Journal of Maxillofacial Oral Surgery . 2012;11(4):430–434. doi: 10.1007/s12663-012-0351-0.
    1. Polak D., Clemer-Shamai N., Shapira L. Incorporating antibiotics into platelet-rich fibrin: a novel antibiotics slow-release biological device. Journal of Clinical Periodontology . 2019;46(2):241–247. doi: 10.1111/jcpe.13063.
    1. Pell G. J., Gregory G. T. Impacted third molars: classification and modified technique for removal. The Dental Digest . 1933;39(9):330–337.
    1. Dohan D. M., Choukroun J., Diss A., et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics . 2006;101(3):37–44.
    1. Dohan D. M., Choukroun J., Diss A., et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics . 2006;101(3):45–50.
    1. Wewers M. E., Lowe N. K. A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing & Health . 1990;13(4):227–236. doi: 10.1002/nur.4770130405.
    1. ÜstÜn Y., Erdoğan Ö., Esen E., Karsli E. D. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics . 2003;96(5):535–539. doi: 10.1016/S1079-2104(03)00464-5.
    1. Happonen R. P., Blckstriim A. C., Ylipaavalniemi P. Prophylactic use of phenoxymethylpenicillin and tinidazole in mandibular third molar surgery, a comparative placebo controlled clinical trial. British Journal of Oral and Maxillofacial Surgery . 1990;28(1):12–15. doi: 10.1016/0266-4356(90)90003-4.
    1. McHenry M. C., Weinstein A. J. Antimicrobial drugs and infections in ambulatory patients: some problems and perspectives. Medical Clinics of North America . 1983;67(1):3–16. doi: 10.1016/S0025-7125(16)31222-6.
    1. Hyland M. E., Sodergren S. C. Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Quality of Life Research . 1996;5(5):469–480. doi: 10.1007/BF00540019.
    1. Roy S., Driggs J., Elgharably H., et al. Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair and Regeneration . 2011;19(6):753–766. doi: 10.1111/j.1524-475X.2011.00740.x.
    1. Hoaglin D. R., Lines G. K. Prevention of localized osteitis in mandibular third-molar sites using platelet-rich fibrin. International Journal of Dentistry . 2013;2013:4. doi: 10.1155/2013/875380.
    1. Strauss F. J., Stähli A., Gruber R. The use of platelet-rich fibrin to enhance the outcomes of implant therapy: a systematic review. Clinical Oral Implants Research . 2018;29(18):6–19. doi: 10.1111/clr.13275.
    1. Blinstein B., Bojarskas S. Efficacy of autologous platelet rich fibrin in bone augmentation and bone regeneration at extraction socket. Stomatologija, Baltic Dental and Maxillofacial Journal . 2018;20(4):111–118.
    1. Bilginaylar K., Uyanık L. O. Evaluation of the effects of platelet-rich fibrin and piezosurgery on outcomes after removal of ımpacted mandibular third molars. British Journal of Oral and Maxillofacial Surgery . 2016;54(6):629–633. doi: 10.1016/j.bjoms.2016.03.016.
    1. Dar M. M., Shah A. A., Najar A. L., Younis M., Kapoor M., Dar J. I. Healing potential of platelet rich fibrin in impacted mandibular third molar extraction sockets. Ann Maxillofacial Surgery . 2018;8(2):206–213. doi: 10.4103/ams.ams_181_18.
    1. Hellem S., Nordenram A. Prevention of postoperative symptoms by general antibiotic treatment and local bandage in removal of mandibular third molars. International Journal of Oral Surgery . 1973;2(6):273–278. doi: 10.1016/S0300-9785(73)80022-5.
    1. Macgregor A. J., Addy A. Value of penicillin in the prevention of pain, swelling and trismus following the removal of ectopic mandibular third molars. International Journal of Oral Surgery . 1980;9(3):166–172. doi: 10.1016/S0300-9785(80)80015-9.
    1. Ren Y. F., Malmstrom H. S. Effectiveness of Antibiotic Prophylaxis in Third Molar Surgery: A Meta- Analysis of Randomized Controlled Clinical Trials. Journal of Oral and Maxillofacial Surgery . 2007;65(10):1909–1921. doi: 10.1016/j.joms.2007.03.004.
    1. Monaco G., Tavernese L., Agostini R., Marchetti C. Evaluation of antibiotic prophylaxis in reducing postoperative infection after mandibular third molar extraction in young patients. Journal of Oral and Maxillofacial Surgery . 2009;67(7):1467–1472. doi: 10.1016/j.joms.2008.12.066.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit