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Does use of local antibiotic as an adjunct to flap surgery confer benefit?

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(Content under development)

The following question was submitted by a practising dentist: What is consensus on using local antibiotic with or without flap involvement? Is raising a flap and using antibiotics significantly better than without?

JCDA Editorial Consultant Dr. Debora Matthews of Dalhousie University provided this initial response for consideration:

When we talk about using antibiotics for our patients we have to think about the risk/benefit ratio. While the risk of systemic side effects is low, other potential risks exist, including increasing bacterial resistance, and the potential for allergic reactions. It is important to ask ourselves if these risks (for the individual patient under consideration) outweigh potential benefits.

Furthermore, there is limited evidence from clinical studies that show any additional benefit over traditional non-surgical therapy alone, and no studies that show a benefit for the use of local antibiotics in addition to surgical therapy.

Any benefits that some studies show are less than one mm difference in probing depths or clinical attachment levels. The American Academy of Periodontology published a position statement on Local Delivery of Antimicrobials as Adjunct Therapy in 2006.

Follow-up: Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply“ below. Comments come directly to me for approval prior to posting. You are welcome to remain anonymous. We will never post your email address in any response. John

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2 Comments

  1. Aldo-Joseph Camarda October 11, 2012

    John,

    As a corollary to Dr. Matthews’s excellent response to this question, regarding application of local antibiotic to 3rd molar flap surgery, I invite the readers to enjoy a recent publication entitled “Proceedings From the Third Molar Multidisciplinary Conference” published as a Supplement to the September 2012 issue, volume 70 no. 9 Supplement 1, of the Journal of Oral and Maxillofacial Surgery. This publication presents an exhaustive literature review of the following topics: Pathology associated with asymptomatic 3rd molars, Surveillance as a management strategy, What strategies are helpful in the operative management of 3rd molars, and what is the effect of removal on the incidence and severity of complications, etc.

    I hope that this may be of help to your readership.

    Best regards,
    Aldo.

    Reply
  2. David Chvartszaid November 1, 2012

    The use of antibiotics during routine periodontal surgery is unwarranted. Studies show an extremely low risk of post-operative infection (e.g., Pack & Haber 1993, http://www.ncbi.nlm.nih.gov/pubmed/6577181). At the same time, the individual and population-wide risks of antibiotic use and overuse are well-acknowledged. The use of systemic antibiotics may however be considered in isolated situations where the risk of post-operative infections or poor healing is elevated (such as surgical interventions on a compromised host and surgical interventions involving placement of foreign materials – e.g., a bone replacement graft).

    Reply

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