Clinical evaluation of antibiotic prophylaxis before endodontic treatment of necrotic teeth

The efficacy of antibiotic prophylaxis before endodontic treatment of necrotic teeth in the prevention of post-treatment flare-up pain and swelling was evaluated.

A total of 47 teeth with diagnosis of pulpal necrosis were selected in 39 patients, independently from the pre-operative symptomatology (painful or asymptomatic). Teeth were randomly divided into 2 groups. The first group (n=23) was given an antibiotic prophylaxis with 2 g amoxicillin 1 h before every appointment; the second group (n=24) did not receive any treatment (control group). The endodontic therapy was performed by shaping canals using the crown-down technique with hand devices, 5% sodium hypochlorite irrigations and 2 intermediate medications with Ca(OH)(2). Obturation was performed using randomly the vertical obturation technique or the no-stop wave technique. At the end of each appointment a questionnaire was given to each patient. The patient had to indicate if pain (absent, light, mild, severe) or swelling were present at 4, 8, 12, 24 h after every appointment. Data were statistically analysed with the Mann-Whitney, Wilcoxon and chi2 test.

Only a case of flare-up pain and swelling was found in a patient of the study group. The statistical analysis showed that there were no significant differences between the 2 groups.

An accurate endodontic treatment of necrotic canals is sufficient to guarantee an adequate control of post-treatment pain, with no need of antibiotic prophylaxis.