title: An evidence-based assessment of the clinical guidelines for replanted avulsed teeth. Part II: prescription of systemic antibiotics.
abstract: BACKGROUND
  Current clinical guidelines recommend prescribing systemic antibiotic therapy (SAT) for patients having an avulsed permanent tooth replanted. The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO question: (P) for a replanted avulsed permanent tooth, (I) is prescribing SAT, (C) compared with not prescribing SAT, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation?
  
  
  METHODS
  A literature search was performed across four internet databases (Ovid Medline, Cochrane Library, PubMed, ISI Web of Science), for relevant citations (n = 35 702). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14 742) that were sieved according to evidence-based dentistry principles. Relevant titles were selected for abstract assessment (n = 782), identifying papers for examination (n = 74). Inclusion criteria were applied and three papers (326 total teeth) met the final criteria for meta-analysis.
  
  
  RESULTS
  Meta-analyses found no statistically significant difference between prescribing or not prescribing antibiotics for acceptable periodontal healing without progressive root resorption (common odds ratio = 0.90, SE = 0.29, 95% confidence intervals = 0.51-1.58).
  
  
  CONCLUSIONS
  The evidence for an association between prescribing SAT and an increased likelihood of acceptable periodontal healing outcome is inconclusive. This investigation of antibiotic use as defined in the clinical guidelines indicates there is inconclusive clinical evidence from studies of replanted avulsed human teeth to either contradict or support the guideline. Pending future research to the contrary, dentists are recommended to follow current guidelines in prescribing SAT when replanting avulsed teeth.
authors.affiliation: Paediatric Dentistry, Melbourne Dental School, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Susan Elisabeth
authors.initials: SE
authors.lastname: Hinckfuss
authors.forename: Louise Brearley
authors.initials: LB
authors.lastname: Messer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019229:Dentition, Permanent; D055094:Evidence-Based Dentistry; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010519:Periodontium / Q000502:physiology; D017410:Practice Guidelines as Topic; D014084:Tooth Avulsion / Q000628:therapy*; D014090:Tooth Replantation / Q000379:methods*; D014945:Wound Healing / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents