title: A Systematic Review on Effect of Single-Dose Preoperative Antibiotics at Surgical Osteotomy Extraction of Lower Third Molars.
abstract: OBJECTIVE
  We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of a single dose of preoperative antibiotic administered perorally, intravenously, intramuscularly, or topically for preventing infection and alveolar osteitis in lower third molar surgical extraction applying osteotomy.
  
  
  METHODS
  The Medline, Cochrane Library, and Embase databases were searched for RCTs until August 2015. The primary outcome measure was postoperative inflammatory reactions, with a subgroup analysis of surgical site infection (SSI) and alveolar osteitis. A risk-of-bias assessment of the included trials was done according to the Cochrane guidelines.
  
  
  RESULTS
  A total of 53 RCTs were identified; however, only 10 could be included in the present review. A meta-analysis of the 10 trials showed a statistically significant reduction in SSI and alveolar osteitis when antibiotics had been used (odds ratio [OR] = 0.30; 95% confidence interval [CI], 0.19 to 0.47; P ≤ .00001). A subgroup meta-analysis of 6 trials showed that preoperative administration of antibiotics perorally or intravenously significantly reduced the incidence of SSI (OR = 0.19; 95% CI, 0.08 to 0.45; P = .0002). A meta-analysis of 5 trials showed that 2 g of preoperative oral amoxicillin was able to reduce the incidence of SSI and the difference was statistically significant (OR = 0.22; 95% CI, 0.08 to 0.59; P = .002). Seven trials reported on alveolar osteitis, 6 studies on oral use, 2 studies on amoxicillin, 2 on metronidazole, 2 on penicillin V, and 1 on the intravenous use of penicillin. The pooled results showed that preoperative antibiotics significantly reduced the prevalence of alveolar osteitis (OR = 0.35; 95% CI, 0.13 to 0.96; P = .04). The subgroup analysis showed that penicillin V was effective in reducing the incidence of alveolar osteitis (OR = 0.1; 95% CI, 0.03 to 0.30; P ≤ .0001).
  
  
  CONCLUSIONS
  A single oral dose of 2 g of amoxicillin before lower third molar osteotomy surgical extraction significantly decreased the incidence of SSI. A single dose of 0.8 g of penicillin V before lower third molar osteotomy surgical extraction significantly decreased the incidence of alveolar osteitis.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Koege University Hospital, Koege, Denmark.
authors.forename: Karoline Brørup
authors.initials: KB
authors.lastname: Marcussen
authors.affiliation: Chief Resident, Department of Clinical Biochemistry, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Anne Sofie
authors.initials: AS
authors.lastname: Laulund
authors.affiliation: Consultant, Department of Clinical Biochemistry, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Henrik L
authors.initials: HL
authors.lastname: Jørgensen
authors.affiliation: Professor, University of Southern Denmark, Faculty of Health Sciences, Institute for Regional Health Sciences; and Consultant, Department of Oral and Maxillofacial Surgery, University of Southern Denmark Hospitals, Hospital of South West Denmark, Esbjerg, Denmark. Electronic address: empinholt@health.sdu.dk.
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Pinholt
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D004368:Dry Socket / Q000517:prevention & control; D006801:Humans; D007273:Injections, Intramuscular; D008964:Molar, Third / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control; D014081:Tooth Extraction / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents