Comparison of the Postoperative Effects of Local Antibiotic versus Systemic Antibiotic with the Use of Platelet-Rich Fibrin on Impacted Mandibular Third Molar Surgery: A Randomized Split-Mouth Study

Use or abuse of antibiotics as prophylactic therapy in oral surgery: A systematic review

BACKGROUD

Antibiotics are a type of medication routinely prescribed by dental professionals; however, it is very common that the administration is not justified. Around 15% of dentists admit that they have administered antibiotics unnecessarily more than once a week. The objective of this project is to identify the effectiveness of the use of antibiotics as prophylactic therapy in oral surgery, and to carry out an analysis of the alternatives to pharmacological therapy.

METHODS

The search strategy was carried out in the PubMed, Scopus, and ScienceDirect databases. For study selection, a first filter was carried out by title and abstract, which mentioned the use of prophylactic antibiotics in some type of oral surgery. To establish the risk of bias, the JBI Critical Appraisal Checklist for Randomized Controlled Trials was utilized.

RESULTS

The type of antibiotics most prescribed as prophylactic therapy were beta-lactams, which were indicated in 100% of the studies. Penicillins predominated, observing amoxicillin as the most indicated drug in 54.1% of the studies (n = 13) followed by the use of amoxicillin in conjunction with clavulanic acid in 33.3% of the studies (n = 8). Of the 21 studies included, 17 mention that there is insufficient evidence to support the use of antibiotics as prophylactic therapy in patients who will undergo some type of oral surgery.

CONCLUSIONS

Without a doubt, the biggest challenge is to develop academic update strategies aimed at dentists with active clinical practice and dental students from educational and government institutions to provide updated information about the correct use of prescription drugs.

Evaluation of advanced platelet-rich fibrin (PRF) as a bio-carrier for ampicillin/sulbactam

OBJECTIVES

Mechanisms of wound healing are often impaired in patients with osteonecrosis of the jaw (ONJ). According to the guidelines for the treatment of this disease, early surgical intervention is indicated. However, surgery often faces complications such as wound healing disorders. The application of platelet-rich fibrin (PRF) after necrosectomy between bone and mucosa may constitute a promising approach to improve surgical results. An aspect that was not investigated until now is that PRF acts as a "bio-carrier" for antibiotics previously applied intravenously.

MATERIALS AND METHODS

We investigated the antimicrobial properties of PRF in 24 patients presenting ONJ undergoing systemic antibiosis with ampicillin/sulbactam. We measured the concentration of ampicillin/sulbactam in plasma and PRF and performed agar diffusion tests. Ampicillin/sulbactam was applied intravenously to the patient 10 minutes for blood sampling for PRF. No further incorporation of patients' blood or PRF product with antibiotic drugs was obtained. Four healthy patients served as controls.

RESULTS

Our results revealed that PRF is highly enriched with ampicillin/sulbactam that is released to the environment. The antibiotic concentration in PRF was comparable to the plasma concentration of ampicillin/sulbactam. The inhibition zone (IZ) of PRF was comparable to the standard ampicillin/sulbactam discs used in sensitivity testing.

CONCLUSIONS

The results of our study demonstrated that PRF is a reliable bio-carrier for systemic applied antibiotics and exhibits a large antimicrobial effect.

CLINICAL RELEVANCE

We describe a clinically useful feature of PRF as a bio-carrier for antibiotics. Especially when applied to poorly perfused tissues and bone such as in ONJ, the local release of antibiotics can reduce wound healing disorders like infections.

Titanium platelet-rich fibrin (T-PRF) as high-capacity doxycycline delivery system

OBJECTIVES

Titanium platelet-rich fibrin (T-PRF), a second-generation autogenous blood concentrate with tough and thick fibrin meshwork activated by a titanium tube, was used as a drug carrier for doxycycline (Doxy) by injection. The objective of this study is to evaluate the loading capacity of T-PRF, release kinetics of doxycycline-loaded T-PRF, and its antibacterial effects against S. aureus and P. aeruginosa.

MATERIALS AND METHODS

The T-PRF and collagen were loaded with Doxy as T-PRF/Doxy and Collagen/Doxy, and their release and antibacterial activities against S. aureus and P. aeruginosa were investigated. Chemical characterization and morphological analysis were performed.

RESULTS

In comparison with collagen, approximately sevenfold more Doxy, 281 mg/g, was loaded into T-PRF. It was found that 25% of the loaded Doxy was released from T-PRF compared to only 12% from collagen within 72 h. The largest inhibition zone diameter (IZD) was observed for T-PRF/Dox with 32 ± 6 mm and 37 ± 5 mm for P. aereginosa and S. aureus, respectively. However, only 10 ± 5 mm and 10 ± 6 mm IZD were observed for bare T-PRF, and no inhibition zone was observed for the Collagen/Doxy group. A dense fibrin structure was visualized on SEM images of the T-PRF/Doxy group compared to the T-PRF group.

CONCLUSIONS

T-PRF has higher Doxy loading capacity and long-acting antibacterial effects compared to collagen. T-PRF was shown to have potential autogenous long-term drug-carrying capability for doxycycline. Also, the potential fibrinophilic properties of Doxy were observed to strengthen the structure of T-PRF.

CLINICAL RELEVANCE

T-PRF is an autogenous drug career with high loading capacity and extended antibacterial effects for doxycycline. Doxycycline molecules can be visible on T-PRF fibers. This study suggests that T-PRF/Dox could be used as a proper antibiotic delivery device in the treatments of periodontitis and peri-implantitis.