Role of antibiotics after periodontal surgery

1. Evaluation of the role of antibiotics in preventing
postoperative complication after routine
periodontal surgery: A comparative clinical study
Presented by,
Bibina George
Mohan RR et al.
JISP 2014; 18(2):205-12.

2. INTRODUCTION
• Periodontitis
• Most important factor that affect outcome of pdl surgical procedure.
 Prevention of infection during and following surgery
Sources:
 Instruments,
 Hands of surgeon and assistant,
 Air of the operatory, and
 Patient’s perioral skin, nostrils, and saliva

3. Preventive Measures
• Strict aseptic protocol
• Anti-infective measures like
• Proper Sterilization
• Disinfection
• Barrier Techniques
• Risks :
• Development of gastrointestinal tract problem
• Colonization of resistant or fungal strains,
• Cross-reaction with other drugs, allergies, and
• Increased cost of treatment

4. AIM:
• To assess the incidence of clinical infection and role of antibiotics in preventing
infection in patients undergoing routine periodontal surgery
• To assess its influence on the surgical outcome.

5. MATERIALS AND METHODS:
• SOURCE OF DATA:
• Patients diagnosed with moderate to severe chronic
periodontitis requiring flap surgery were recruited from the Department of
Periodontics, Oxford Dental College, Bangalore.
• Ethical clearance:
Reviewed and approved by the college’s ethical committee.
45
Systemically
healthy
25-55 yrs

6. SELECTION CRITERIA
INCLUSION CRITERIA
• Age : 25 - 55 years with moderate to
severe chronic periodontitis
• Systemically healthy patients fit for
periodontal surgery
• Patients with good oral hygiene
maintenance.
EXCLUSION CRITERIA
• Allergic to Amoxicillin and Doxycycline
• Pregnant patients
• Smokers
• Previous periodontal surgery done in the
same area
• Antibiotic therapy taken 3 months prior to
surgery.

7. Experimental Design:
Clinical Parameters
• Plaque Index (Silness and
Loe )
• Gingival Index (Loe and
Silness)
• Probing pocket depth (PPD)
• Clinical attachment loss
measurements
• Gingival Recession (GR)
• Tooth Mobility
Postop Evaluation
• Pain
• Swelling
• Increase in temp.
TIME PERIOD
• Baseline
• 3 months

8. PERIODONTAL TREATMENT
NSAID
Ibuprofen – 400 mg + Paracetamol -333 mg 9
1-1-1 x 3days
• Fumigated enclosed surgical rooms
• Autoclaved wear for operator, assistant
• Bacillol 25 disinfected dental operatory
• Al foils for exposed areas
• High vol. evacuation suction
• Spittoon and tumbler water lines flushed
for atleast 5 min before and after surg
proced.
SURGICAL
PRECAUTIONS
Started 1 day prior to Surgery and
continued for 5 days
Ptnt
Povidone Iodine presurg. Facial scrub
Pre proced mouth rinse with 10 ml 0.2 %
CHX
Grp I : Amox -500 mg
1-1-1x 5 days
Grp II : Doxy – 200 mg 5
0-0-1 x 1 day
100 mg 0-0-1 x 4 days
Grp III : Control Group
15
Surgeon & Assistant
Presurg. Scrub
INSTRUMENTS
Precleaned----Seggregated--
---Autoclavable sealed
pouches with chemical
spore testing strips------
Autoclaved

9. • Continue med.
• Abstain brushing on surg site for
atleast 2 weeks
• CHX (0.2%) BD x 30 days
Periodontal dressing and suture removed after 1 week

10. STATISICAL ANALYSIS :
• ANOVA test
• Chi square / Fisher’s exact test

11. RESULTS:

12. 38.27
37.27
39.93

14. 0.58 0.510.47
0.18 0.19
0.20

16. DISCUSSION :
• Results of the study clearly showed that properly performed periodontal surgery does not
result in post-surgical infection or any complications.
• Amply substantiated by lack of any undesirable outcome.
• Most of the dental practitioners prefer Amoxicillin
• Majority of the periodontists prefer Doxycycline for its effect against periodontal
pathogens due to convenience of its usage, which thereby improves patient compliance.
• Metronidazole was not considered, as patient compliance has been found to be poor due
to its side effects

17. Review of Literature :
• Feres et al. Perio 2000.(2015) suggested in his systemic review that chances of
development of antibiotic resistant strains should be given more consideration
rather than getting very small (0.1 mm) of CAL gain in periodontal tissues while
prescribing antibiotics.
• Based on systematic reviews of Herrera et al (2002) and Haffajee et al (2003)
benefit of Antibiotics in gaining attachment was observed in moderate to severe
periodontitis cases with deep periodontal pockets.

18. • Powell CA, Mealy BL, Deas DE, McDonnel HT, Moritz AJ. Post surgical infections:
Prevalence associated with various periodontal surgical procedures. J Periodontol
2005;76:329-333. describes a large-scale retrospective study of multiple surgical modalities
in a diverse periodontal practice undertaken to explore the prevalence of clinical infections
post-surgically and the relationship between diverse treatment variables and infection rates
and concluded that although perioperative antibiotics are commonly used when performing
certain regenerative and implant surgical procedures, there may be no benefit in using
antibiotics for the sole purpose of preventing post-surgical infections..

19. • Dastoor SF, Travan S, Neiva RF, Rayburn LA, Giannobile WV, Wang HL, et al.
Effects of adjunctive systemic azithromycin with periodontal surgery in the
treatment of chronic periodontitis in smokers: A pilot study. J Periodontol
2007;78:1887-96. demonstrated that in heavy smokers, adjunctive systemic AZM in
combination with pocket reduction surgery did not significantly enhance PD
reduction or CAL gain. However, the clinical value of adjunctive AZM may be
appreciated by more rapid wound healing, less short-term gingival inflammation, and
sustained reductions of periopathogenic bacteria.

20. CONCLUSION :
• Prophylactic medication of patients with antibiotics who are otherwise
healthy following routinely properly performed periodontal surgery is
unnecessary and has no demonstrable additional benefits.
• Further studies need to be conducted in different clinical settings before
recommending changes in the antibiotic policy for surgical procedures.