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Inconclusive evidence for the association between systemic antibiotics and periodontal healing of replanted avulsed teeth Critical Summary Prepared by: Donald L. Chi D.D.S., PhD 

OVERVIEW

  • Systematic Review Conclusion:

    There was limited evidence to demonstrate the healing benefits associated with systemic antibiotics for replanted avulsed teeth.

  • Critical Summary Assessment:

    The review found no significant difference in periodontal healing between patients with a replanted avulsed tooth who were treated with systemic antibiotics compared to those who were not treated with systemic antibiotics. The evidence is inconclusive because all studies in the review were retrospective and patients were not randomly assigned to a treatment group, which increases the likelihood of residual confounding (e.g., other factors not accounted for might explain the findings of no significant difference in periodontal healing).

  • Evidence Quality Rating:

    Limited

  • Clinical Questions:

    When replanting avulsed teeth, is there a difference in periodontal healing for patients who received systemic antibiotics versus those who did not receive systemic antibiotics?

  • Review Methods:

    The authors searched four electronic databases. They identified three published studies (326 teeth, assumed to be from different patients) that examined periodontal healing outcomes associated with prescribing systemic antibiotics for a replanted avulsed anterior tooth. They used periodontal healing as the treatment outcome, which they defined as an intact PDL space, tooth mobility equal to the control tooth, and no signs of root resorption.

  • Main Results:

    The authors combined data using a random effects model. In patients with a replanted avulsed tooth, they found no significant difference in periodontal healing between those treated with systemic antibiotic therapy and those who not treated (pooled odds ratio 0.90, 95 percent confidence interval 0.51-1.58). There was no information on dose, duration, or type of antibiotic

  • Conclusion:

    Since there is inconclusive evidence for improved periodontal healing associated with systemic antibiotics for a replanted avulsed tooth, clinicians should continue to abide by current guidelines that recommend prescribing systemic antibiotics in this clinical scenario.

  • Source of funding:

    Research Committee of the School of Dental Science, University of Melbourne, Australia

Commentary:

  • Importance and Context:

    Current clinical guidelines recommend that patients undergoing replantation of an avulsed permanent tooth should receive systemic antibiotics to improve periodontal healing. However, these guidelines are not based on an evidence-based review of existing studies.

  • Strengths and Weaknesses of the Systematic Review:

    The authors used standardized methods to identify and select appropriate studies for inclusion. Strengths of the review included an assessment of the extent to which heterogeneity existed across the studies and the use of a random effects model to estimate the pooled odds ratio. The authors identified three studies in the grey literature, but they excluded them. Their lack of explanation for this exclusion considerably weakened the review. In addition, the authors did not assess the quality of the included studies and failed to assess the review for possible publication bias.

  • Strengths and Weaknesses of the Evidence:

    Although there were only three studies included in this systematic review (a total of 326 teeth), the results of the review were consistent with findings from the individual studies, all of which reported no difference in periodontal healing associated with the use of systemic antibiotics. However, this evidence is inconclusive because the included studies were retrospective and none was a prospective randomized clinical trial. Furthermore, the reviewed studies did not address other tooth-related factors (e.g., root apex status, extraoral dry time of the avulsed tooth) that may affect the possible benefits of antibiotic use on periodontal healing. In addition, the authors did not assess the type, dose, and duration of antibiotic used or patient-related factors such as compliance with antibiotic use, which raises uncertainty about which cases and controls may have differed on baseline characteristics. The treatment or control groups were not randomized, which may have yielded in poorly controlled study data.

  • Implications for Dental Practice:

    There is inconclusive evidence for the use of systemic antibiotics for patients with a replanted avulsed tooth. Practitioners should consider this in discussions with patients regarding the likelihood of periodontal healing associated with antibiotic use when replanting avulsed permanent teeth.

  • Critical Summary Publication Date: 6/15/2010

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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