Effect of Antibiotics on Clinical and Laboratory Outcomes After Mandibular Third Molar Surgery: A Double-Blind Randomized Clinical Trial

Abstract

Objectives: This double-blind, randomized clinical trial aimed to evaluate the impact of 2 g of pre-operative amoxicillin on postoperative clinical outcomes and salivary prostaglandin E2 (PGE2) concentration following mandibular third molar removal. Methods: Eighteen healthy adult patients requiring impacted mandibular third molar extraction were randomly assigned to two groups: an experimental group (EG) receiving 2 g of amoxicillin and a placebo group (PG) receiving empty capsules, one hour before the surgery and before taking the first saliva sample. Primary outcomes measured were pain levels at different time points and salivary PGE2 concentrations measured before, 24 h, and 7 days after the surgery, while secondary outcomes included changes in maximum mouth opening (MMO) immediately after the surgery at 1 day and a week post-surgery, and facial swelling at 24 h and 7 days post-surgery. Results: The results showed no significant differences between the EG and PG in terms of pain levels, salivary PGE2 concentration, MMO changes, or facial swelling at different time points (p-values > 0.05). One instance of surgical site infection was noted in the PG in the 7-day follow-up session, but it was not statistically significant (p-value = 0.303). Correlation analyses indicated that a higher number of sutures and a higher difficulty index of surgery were associated with increased pain, while longer surgery duration and osteotomy were linked to more MMO changes and facial swelling (p-values < 0.05). In addition, while longer surgery duration and performing tooth section were correlated with lower PGE2 concentrations, PGE2 concentrations were positively correlated with pain levels (p-values < 0.05). Conclusions: Based on the results of this study, administering 2 g of prophylactic amoxicillin did not significantly affect postoperative clinical or laboratory outcomes in healthy patients undergoing mandibular third molar surgery.