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.

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.

Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study.

OBJECTIVES: Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. METHODS: This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). RESULTS: The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. CONCLUSIONS AND CLINICAL RELEVANCE: Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

¿Está indicada la prescripción de antibióticos en la extracción del tercer molar retenido?: estudio comparativo entre patrones de prescripción / Is it necessary to prescribe antibiotics in impacted third molar surgical removal?: comparative study between prescribing patterns

Objetivo. Valorar si existe una diferencia significativa en tasa de infección tras cirugía de extracción dentaria en dos hospitales de Noruega y España, donde se aplican protocolos de profilaxis quirúrgica diferentes. Material y Métodos. Se realizó un estudio observacional analítico, tipo cohortes retrospectivo, analizando pacientes sanos, sin factores de riesgo, operados de tercer molar incluido en los servicios de maxilofacial de dos hospitales diferentes: St. Olav de Trondheim (Noruega) y Clínico San Carlos de Madrid (España). Se recogieron las variables: edad, número de piezas extraídas, tipo de anestesia, y observaciones recogidas en la historia clínica sobre el curso de la operación. Para valorar el desarrollo infección postoperatoria se recogieron los datos de los pacientes que escogieron el hospital como lugar de retirada de los puntos en el Hospital St. Olav, y en el Hospital Clínico San Carlos se llevó a cabo una encuesta telefónica para conocer el curso de la operación meses después. Resultados. El 11,1% de los pacientes operados en el Hospital St. Olav recibió pauta antibiótica durante una semana tras la operación, mientras que en el Hospital Clínico San Carlos fue del 100%. La tasa de infección tras ésta fue del 15% en el Hospital de St. Olav y del 7,5% en el Hospital Clínico siendo estas diferencias no estadísticamente significativas. Conclusiones. La administración sistemática de antibiótico a pacientes sanos sin factores de riesgo sometidos a extracción quirúrgica del tercer molar retenido es una práctica rutinaria en clínica que no parece estar justificada (AU)

Objective. To assess whether there is a significant difference in infection rate after surgery tooth extraction in two different hospitals from Norway and Spain where different surgical antimicrobial prophylaxis protocols are applied. Methods. An analytical observational study was conducted, retrospective cohorts type, analyzing healthy patients with no risk factors, who were third molar tooth operated in maxillofacial services of two different hospitals: St. Olav in Trondheim (Norway) and Clínico San Carlos in Madrid (Spain). The collected variables were: age, number of tooth removed, anesthesia type, and observations about the course of the operation registered in the clinical history. To assess the development of postoperative infection, patient’s data of those who chose the hospital as the place to remove the suture thread were collected in Norway, whereas in Spain a telephone survey was conducted to determine the course of the operation months later. Results. In St. Olav Hospital 11.1% of patients operated received antibiotic regimen after surgery, while in Hospital San Carlos were 100%. The infection rate was 15% in St.Olav Hospital and 7.5% in Hospital San Carlos. These differences were no statistically significant. Conclusions. The routine administration of antibiotics to healthy patients with no risk factors undergoing impacted third molar surgical removal is a common clinical practice which it does not seem to be justified (AU)

The value of the dental impaction pain model in drug development.

The modern version of the Dental Impaction Pain Model (DIPM) was developed in the mid-1970s. Since that time, several hundred studies have been conducted by numerous investigators. Today it is arguably the most utilized of all the acute pain models. Its popularity is due to the success rate of the studies, fast subject entry, and cost effectiveness. The surgical procedure is extremely standardized, and the surgery requires either minimal or no use of CNS depressant anesthetics. The methodology is similar to that utilized in other acute pain models; however, the DIPM is much more versatile than most other models. The model can be easily adapted to perform multiple-dose studies, pharmacokinetics/pharmacodynamics (PK/PD) correlations, preemptive interventions, and sleep-pain studies. A few investigators have even developed microdialysis techniques, wherein they insert probes into extraction sockets to collect exudates for measuring biochemical mediators of pain or drug levels at the site of injury. In many instances, an accomplished site can complete a study of several hundred subjects in approximately 3 months. There are studies in the literature that have incorporated up to six treatment arms in one study and clearly separated the drugs from each other. The exquisite assay sensitivity is due to the homogeneity of the study population, the predictable level and appropriate intensity of the postsurgical pain, and the minimizing of variability by using only one or two study centers. The DIPM has been employed to evaluate NSAIDs (both nonselective and selective Cox inhibitors), opioids and combination analgesics, as well as some investigational drugs with unique mechanisms of action. The model is particularly useful for proof-of-concept studies that require dose-ranging and profiling the time-effect curve for efficacy including onset, peak effect, and duration of analgesic activity.

[Clinical, topographic, and morphological characteristics of pathological processes in the retromolar zone]. / Klinicheskie i topografomorfologicheskie osobennosti patologicheskikh protsessov retromoliarnoi oblasti.

Morphological variants of 20 tissue fragments of mandibular retromolar space were analyzed and the data were used for developing a protocol of treatment of difficult eruption of the mandibular third molar using biocomposite materials.

[The evaluation of the clinical efficacy and tolerance of azithromycin in odontostomatological infections]. / Valutazione dell'efficacia clinica e della tollerabilità dell'azitromicina nelle infezioni odontostomatologiche.

BACKGROUND: Common oral bacteria are involved in the etiology of odontostomatological infections and there is a prevalence of Gram negative anaerobic microorganisms that are increasingly often found to be resistant to common beta-lactamases. In the light of this phenomenon, the use of beta-lactamases has been replaced by macrolides. The development of azithromycin, which is active against anaerobes and characterised by a wider spectrum of action against Gram negative bacteria, has opened new horizons in the therapeutic approach to odontostomatological infections. AIMS: The aim of the study was to evaluate the clinical efficacy and the tolerability of azithromycin in odontostomatological infections. The study was performed using an open test method, without a comparative drug. METHODS: One hundred patients, including 51 males and 49 females aged between 18 and 64 years old, were included in the study. These patients showed clinical and radiographic symptoms of acute apical periodontitis, periodontal abscess, or third molar dysodontiasis. They were divided into three groups. The drug protocol used was 500 mg/day for three days. The efficacy of the antibiotic was assessed one week after the start of treatment by evaluating the evolution of the pathology on the basis of subjective symptoms (pain) and objective signs (reddening, swelling, basal temperature). A progressive system was used to quantify the clinical findings using an arbitrary score from 0 to 3. The tolerability of treatment was evaluated by recording any signs observed in the patients' data records. RESULTS: The initial mean score for painful symptoms passed from 2.88 to 0.34. The initial mean score for the reddening parameter also fell from 2.3 to 0.34. The same results were found for the reddening sign which presented a mean value of 2.1 at the start of treatment and 0.38 at the end. The 8 patients who presented fever also showed a remission. The overall incidence of side effects was 8%. The side effects affected the gastrointestinal tract. CONCLUSIONS: From an analysis of these results it can be affirmed that azithromycin achieved good therapeutic results in odontostomatological infections in terms of both efficacy and tolerability.

Clinical and microbiological effects of in vivo miocamycin therapy on oral infections and in surgical prophylaxis.

Periodontal disease is a chronic irregularly progressing condition, posing many therapeutic problems. Difficulties arise particularly when antibiotic therapy is to be added to mechanical and surgical therapy because, in these cases, pharmacotherapy must be long-lasting. For such reasons the antibiotic of choice must have high activity but low toxicity, in order to avoid side-effects. Antibiotic therapy is also used in both marginal and apical acute phlogistic cases, so that the ideal compound should have high diffusion in gingival tissues and alveolar bone. Miocamycin shows all of these features and it can thus be considered the antibiotic of choice in the therapy of acute periodontal infections and in stomatological surgery. In this clinical study the efficacy of miocamycin has been evaluated in 120 cases of acute periodontal phlogosis and in the treatment of advanced periodontal diseases. Patients were microbiologically monitored for the identification of aerobic and anaerobic bacteria all through the study. In acute cases very good results were obtained, both concerning the reduction of pathological signs (94.1% of the cases) and the occurrence of side-effects (10% of the cases). Among the patients who underwent surgical therapy, only 11 out of 80 showed small problems (slight fever and swelling).