A Comparative Clinical Study to Assess the Role of Antibiotics in Periodontal Flap Surgery.

Introduction: Periodontitis is a multifaceted disease that results from the intricate interplay of infectious pathogens and host factors. Periodontal surgical techniques may be required in moderate to severe cases of chronic periodontitis. As a result of the potential for postoperative infection to have a substantial impact on the surgical outcome, an attempt will be made in the study to assess the role of antibiotics in periodontal flap procedures in minimizing postoperative infections. Methodology: From the Department of Periodontics and Oral Implantology, 30 patients (male and female) with moderate to severe chronic periodontitis were chosen. Amoxicillin 500 mg three times a day for 5 days following surgery was given in the therapeutic group (15 patients). Antibiotics were not provided to the control group (15 patients) after surgery. Both groups were administered analgesics and antiseptic mouthwash. On the seventh day after suture removal, patients were assessed for pain (measured on a visual analogue scale [VAS]), modified gingival index, wound healing index, swelling, fever, ulceration, and delayed wound healing.
Results: The VAS reported in the control group was 2.67, while the VAS recorded in the therapeutic group was 2.20. The mean modified gingival index score in the control group was 0.94, while it was 0.67 in the therapeutic group. The mean Wound Healing Index score in the control group was 3.80, whereas it was 3.97 in the therapeutic group. When antibiotics were administered to patients, they reported less pain and faster wound healing. Following flap surgery with or without antibiotics, however, there were no statistically significant variations in all clinical measures.
Conclusion: The findings of our study imply that antibiotics for the sole goal of avoiding postsurgical infections may not be beneficial. Copyright:

INTRODUCTION

Periodontitis is a multifaceted disease that results from the intricate interplay of infectious pathogens and host factors.

Periodontal surgical techniques may be required in moderate to severe cases of chronic periodontitis. The most important factor affecting the outcome of periodontal surgical procedures is infection prevention during and after surgery.[1]

Periodontal surgical procedures are inherently risky since they might result in complications, one of which is infection. Careful mechanical debridement by professionals, antiseptic therapy with dressings and/or rinses, as well as systemic antibiotic administration are all included in this treatment plan.[2]

According to a number of studies, using preoperative antibiotics to minimize pain and swelling as well as enhance wound healing and treatment may lower the risk of postoperative infection.[3]

Furthermore, infection rates after periodontal surgery without antibiotics have been reported to be minimal, ranging from less than 1% to 4.4% for standard periodontal surgery and 4.5% for implant surgery.[3]

An attempt has been made in this clinical investigation to investigate the impact of antibiotics in periodontal flap surgeries in minimizing post-surgical infections.

MATERIALS AND METHODS

Data came from the following sources

A comparative clinical trial is the type of study; 30 patients (male and female) with moderate to severe chronic periodontitis were chosen from the Department of Periodontics and Oral Implantology.

DATA COLLECTION METHODOLOGY

The study involved 30 patients with moderate to severe chronic periodontitis who required periodontal flap operations.

One-year study period: This study lasted 1 year. On the day of suture removal, 1 week after surgery, all exams and clinical parameters were documented. After surgery, patients will be observed for 1 month.

The following are the criteria for choosing a subject:

Inclusion criteria

Patients between the ages of 20 and 60 who are in good health on the whole.

Patients who needed periodontal surgery and had not taken antibiotics in the 6 months before to the start of the research.

Patients have persistent periodontitis that is mild to severe.

Exclusion criteria

Patients had poor oral hygiene compliance during and after phase I treatment.

Patients with systemic diseases or illnesses that interfere with healing, as well as those who need prophylactic antibiotics.

Immunocompromised

Smokers.

Women who are pregnant or nursing.

Parameters evaluated

Patients were assessed for both immediate and increasing pain (measured on visual analogue scale [VAS]).

Lobene et al.[4] modified gingival index (1986).

Landry et al.[5] Wound Healing Index (1988).

Swelling, fever, ulceration, and both immediate and gradual wound healing delays.

All of the tests were completed 1 week after the surgery, on the day of suture removal. After surgery, the individuals will be examined for 1 month to see if there are any delayed issues. Patients were assessed for both immediate and increasing pain (measured on VAS).

STUDY DESIGN

A total of 30 patients aged 20 to 60 years with moderate to severe chronic periodontitis requiring flap procedures will be chosen from the Department of Periodontics and Oral Implantology for a comparative clinical study.

After completing Phase I therapy, which included oral hygiene recommendations as well as scaling and root planning, a periodontal evaluation will be performed 3 weeks after Phase I therapy to confirm the suitability of sites for periodontal flap surgery. In all periodontal flap surgical procedures, strict aseptic protocol and infection control measures will be followed. The participants will be assigned to one of two groups at random:

Antibiotics were prescribed to the treatment group (15 patients).

After surgery, 500 mg amoxicillin three times a day for 5 days. Antiseptic mouthwash and analgesics were also prescribed.

Antibiotics were not given to the control group (15 patients) after surgery. Analgesics and antiseptic mouthwash were the only medications prescribed. Antibiotics were prescribed to the treatment group (15 patients).

On the day of suture removal, clinical parameters were recorded after 1 week. After surgery, the individuals were observed for 1 month to see if there were any delayed issues.

RESULTS

Age and gender of patients

The study enrolled a total of 18 male and 12 female patients [Table 1], with gender evenly distributed.

Table 1

Gender distribution

Gender	Control group n	Therapeutic group n
Male	8	10
Female	7	5
Total	15	15

The patients' ages varied from 18 to 53 years, with a mean age of 32.9 years in the control group and 37.27 years in the therapeutic group [Table 2], suggesting that the groups were similar in age.

Table 2

Age comparison between control and therapeutic groups

Group	Min	Max	Mean	SD
Control	21	46	32.9	4.5
Therapeutic	17	50	35.5	8.5

In VAS, Modified gingival index (MGI) and Wound healing index (WHI), there was a comparison between the control and therapeutic groups. The mean VAS in the control group was 2.67, while the mean VAS in the therapeutic group was 2.20 [Table 3]. The VAS ratings between the groups did not differ statistically significant. The control group's mean modified gingival index score was 0.94, while the therapeutic group's mean modified gingival index score was 0.67 [Table 3]. The adjusted gingival index scores did not differ statistically significantly between the groups.

Table 3

Mean comparison between control and therapeutic groups in Vas, MGI, and WHI

Clinical variables	Group	Min	Max	Mean	SD	Mean±SD	P
VAS	Control	2.00	5.87	2.67	1.21	0.37±0.48	0.32
	Therapeutic	2.00	3.29	2.20	0.39		NS
MGI	Control	0.12	1.21	0.89	0.44	0.21±0.03	0.33
	Therapeutic	0.12	1.45	0.22	0.29		NS
WHI	Control	3.00	4.00	2.99	0.35	0.15±0.22	0.19
	Therapeutic	3.50	4.00	3.34	0.18		NS

Statistical analysis: Independent samplet test. Statistically significant if P<0.05.

The control group's mean Wound Healing Index score was 3.80, whereas the therapeutic group's mean Wound Healing Index score was 3.97 [Table 3]. Between the groups, there was a statistically significant difference in Wound Healing Index values. Fever, edema, delayed wound healing, and ulceration symptoms in the control and therapeutic groups were compared.

One patient in each group experienced postoperative fever and edema, while three patients in the control group experienced delayed wound healing. There were no ulcers in any of the groups Table 4. In general, none of the factors given above had statistical significance between the groups. There was no statistically significant difference in the frequency of infection after flap surgery with or without grafting between the two groups. This study found that there was no statistically significant difference in infection rates between patients who received bone grafts and those who had bone surgery.

Table 4

Comparison fever, swelling, delay wound healing, and ulceration symptoms between control and therapeutic groups

Clinical variables	Groups	Present n (%)	Absent n (%)	Total n (%)	P
Fever	Control	1 (6.7)	14 (93.7)	15 (100)	1.000
	Therapeutic	1 (6.7)	14 (93.7)	15 (100)	NS
	Total	2 (6.7)	28 (93.7)	30 (100)
Swelling	Control	1 (6.7)	14 (93.7)	15 (100)	1.000
	Therapeutic	1 (6.7)	14 (93.7)	15 (100)	NS
	Total	2 (6.7)	28 (93.7)	30 (100)
Delay wound healing	Control	3 (20.0)	12	15 (100)	0.224
	Therapeutic	0 (0.0)	15 (100)	15 (100)	NS
	Total	3 (10.0)	27 (90.0)	30 (100.0)
Ulceration	Control	0 (0.0)	15 (100)	15 (100)	1.000
	Therapeutic	0 (0.0)	15 (100)	15 (100)	NS
	Total	0 (0.0)	30 (100)	30 (100)

Statistical analysis: Fisher’s exact test. Statistically significant if P<0.05.

DISCUSSION

Infectious microorganisms and host factors interact in a complicated way to generate periodontitis, a disease with several manifestations. As a result of the loss of connective tissue and bone, a condition known as periodontitis may lead to tooth loss if it is not addressed.[6]

Only a few of the hundreds of microorganisms that populate the oral cavity have been shown during the last three decades to be strongly linked to periodontitis.[7] As a determinant in periodontitis susceptibility, the immune-inflammatory response of the host plays a crucial role in tissue damage.[8]

The green complex includes Aggregatibacter actinomycetemcomitans, which has a high link with aggressive periodontitis but a less common association with chronic periodontitis.[9] Pathogens such as Porphyromonas gingivalis, A actinomycetemcomitans, and others contain virulence factors that may evade the host response and destroy periodontal tissue.[1011]

Scaling and Root Planing (SRP) is the gold standard in nonsurgical periodontal treatment, although it is a difficult technique. Anatomical considerations (furcation involvement, tooth type, and surface) as well as the operator's experience limit its effectiveness. As previously stated, as pocket probing depths grow, SRP loses some of its capacity to remove subgingival biofilm.[1213]

SRP treatment demands a great amount of time and effort in individuals with severe chronic periodontitis. Systemic antibiotics may appear to be an acceptable option to SRP for eradicating subgingival bacteria. Several reviews have looked into this subject, but only a few studies have been expressly designed to address it.[1415]

Several extensive evaluations have assessed the efficacy of a combination of SRP and systemic antibiotics in the treatment of chronic periodontitis,[16] concluding that the combination of systemic antibiotics with SRP is more effective than SRP alone. Instruments, surgeons' and assistants' hands, the operatory air, and the patient's perioral skin, nose, and saliva are all potential sources of infection during oral surgery.[17]

Periodontal surgical procedures are inherently risky, with infection being one among them. Infection is defined as “pathogenic organisms invading body tissues.”[18] Infections discovered after surgery are easily treated with local antibiotics and, in some cases, systemic medicines. Antibiotics are commonly used to prevent bacterial endocarditis[19] and periodontal surgery in medically impaired patients or those with aggressive periodontitis[20] in a targeted effort to prevent postoperative infections.

To avoid this problem, which is typically empirical, a surgeon may choose to utilize systemic antibiotics.

For this reason, systemic antibiotics should be used with caution after periodontal surgery since they provide a number of dangers, such as bacterial resistance stimulation, hypersensitivity or allergic response, and drug combinations with other medicines.[21]

CONCLUSION

Keeping the patient safe from infection following surgery depends on a number of other things. As a consequence, the use of antibiotics should be tailored to the specific needs of the procedure rather than being used as a general precautionary measure.

According to the findings of this study, current periodontics encompasses a broad variety of surgical treatments with a low incidence of postoperative infections. Therefore, we advocate performing large-scale, controlled clinical studies to further substantiate the significance of antibiotics in preventing post-surgical infections and overall outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.