Do antibiotics prevent infection after third molar surgery? A network meta-analysis.

Area of Science:

• Oral and Maxillofacial Surgery
• Infectious Diseases
• Pharmacology

Background:

• Third molar surgery is associated with risks of infection and dry socket.
• The prophylactic use of antibiotics is a common practice, but its efficacy requires systematic evaluation.

Purpose of the Study:

• To systematically review and perform a network meta-analysis (NMA) on the effectiveness of antibiotics versus placebo in preventing infection or dry socket after third molar surgery.

Main Methods:

• Systematic review and NMA of 34 randomized clinical trials (RCTs) from 58 identified studies.
• Searches conducted across four databases and grey literature, with study selection based on PICOS criteria.
• Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed.

Main Results:

• Amoxicillin (RR 0.56) and metronidazole (RR 0.51) significantly reduced the risk of infection and dry socket compared to placebo (low quality of evidence).
• Specific effective regimens include postoperative amoxicillin, amoxicillin plus clavulanate, and preoperative metronidazole.
• The observed effects were based on a low certainty of evidence.

Conclusions:

• Antibiotics, specifically amoxicillin and metronidazole, demonstrate efficacy in preventing infection and dry socket post-third molar surgery.
• Clinical decisions regarding antibiotic prophylaxis should weigh benefits against the low incidence of infection and the potential for antibiotic resistance.