Antibiotics in third molar extraction; are they really necessary: A non-inferiority randomized controlled trial

INTRODUCTION: Antibiotic resistance is now a serious problem, although it was not so only a few years ago. The need of the hour is to give clear evidence of the efficacy of antibiotic use, or lack thereof, to the surgeon for a procedure as common as mandibular third molar surgery. AIM: This study aimed to evaluate whether postoperative combined amoxicillin and clavulanic acid in mandibular third molar extraction is effective in preventing inflammatory complications. STUDY AND DESIGN: The study was structured as a prospective randomized double-blind placebo-controlled clinical trial. MATERIALS AND METHODS: A study was designed wherein the 96 units (two bilaterally similar impacted mandibular third molars per head in 48 patients) were randomly assigned to two treatment groups (Group I and Group II). Each patient served as his/her own control. Each patient received 625 mg of combined amoxicillin and clavulanic acid 1 h before surgery. In the case of third molars belonging to Group I, 625 mg of combined amoxicillin and clavulanic acid TDS was continued for 3 days; in Group II, placebo in similar-looking packs was continued for 3 days. The patients were evaluated on the third and seventh postoperative days for signs of clinical infection and for microbial load evaluation. STATISTICAL ANALYSIS: The data between the two groups were statistically analyzed by the two-tailed Fisher's exact test, with a 95% confidence interval. RESULTS: The difference was not statistically significant between the test group and the control group with regard to erythema, dehiscence, swelling, pain, trismus, and infection based on microbial load. The data were statistically significant for alveolar osteitis, with the occurrence of alveolar osteitis (14.58%) in the placebo group. CONCLUSION: Postoperative antibiotics are recommended only for patients undergoing contaminated, long-duration surgery.