Antimicrobial Prophylaxis in Endodontic surgery Article 2022

Antimicrobial Prophylaxis in Endodontic surgery
Evidence Based Dentistry-Professional Project
Critical Appraisal Assignment
Student Number: BP0204333

Table of Contents
1.Introduction.............................................................................................................................3
1.2 Rationale of the study.......................................................................................................3
1.3 Research Questions..........................................................................................................6
2.Critical Appraisal..................................................................Error! Bookmark not defined.
2.1 Article assessment..........................................................Error! Bookmark not defined.
3. Conclusion..............................................................................................................................7

1. Introduction
Antibiotics are life-saving treatment modality for infections. Antibiotics are often misused,
and its adverse effects have been increasingly reported in the healthcare literature
(Ramachandran, et al., 2019). Multidisciplinary approach among dentists, pharmacists, and
patients is needed to steward antibiotic. Puranik et al. (2018) demonstrated that in recent
times there has been an increased number of reports of antibiotic resistance in dentoalveolar
infections. Antibiotics are mainly used for 3 distinct reasons in dentistry namely: preventing
surgical site infections, that concerns with the infection that arises of the surgically handled
tissues; second for the purpose of prophylaxis against remote infections, that mainly concerns
infection that may arise anywhere within the body after the surgical procedure and finally, as
a therapeutic means after the surgery (Puranik et al., 2018). Many clinicians are questioning
the usefulness of prophylactic use of antibiotics and its capability to prevent the risk of
surgical site infection for those individuals who have undergone endodontic surgery (Puranik
et al., 2018). This paper will comprehensively aim to review the efficacy of antibiotic
prophylaxis in endodontic surgeries and whether it is really necessary or not in preventing
surgical site infection.
1.2 Rationale of the study
The usage of antibiotics in surgical endodontics, whether post-operative or pre-operative is
controversial (Zuolo et al., 2000; Siqueira, 2002). However, an article reviewing the efficacy
of antibiotic prophylaxis provided to patients undergoing endodontic surgery stated that there
is no valid evidence to support its use (Longman et al, 2000). Antibiotic prophylaxis in
endodontic surgery is often used based on clinical experience without strong evidence to
support it. Clinicians used it with the hope to prevent postoperative infection and to maximize
the chance for the procedure to be successful. To measure the efficiency of the usage of
antibiotics in hopes for prevention of infection in endodontic surgery, Lindeboom et al (2005)

conducted an RCT on the effectiveness of antibiotic prophylaxis in endodontic surgery. The
study comprised of 256 patients. The group was given either 600mg tablet of clindamycin or
placebo. From the results, it was observed that two patients in the clindamycin group while
four of the patients in placebo group developed postoperative infection. Lindeboom et al
(2005) found that 2 and 4 patients out of a sample of 256 patients was not statistically
significant to justifythe use of the antibiotic as prophylaxis. The average surgical time was
about 30 minutes in both the groups and the overall number of infections was low in both
groups. The results found that 1.6% of patients administered with clindamycin and 3.2%
patients administered with placebo experienced postoperative infection. The difference of
1.6% is a very small, and hence no statistical or biological significance can be concluded.
PICO framework was used to design the research question of the above mentioned study that
compared patients who received clindamycin prophylaxis and those who did not. The
findings of the study indicated that there was no statistically significant difference between
the outcomes on the two groups. The study was of considerable methodological quality. The
patients were allocated into their study groups randomly, but the randomization strategy is
not mentioned. The patients and surgeons were blinded to the study and drug administration
was supervised by an independent nurse. All participants were followed to assess the wound-
healing. The critical appraisal is demonstrated in table 1.
Table 1: JADAD score for Lindeboom et al. (2005).
Item Score
Randomized? 1
Method used to generate the sequence of
randomization described and appropriate?
-1
Double blind? 1
Method of double blinding described and
appropriate?
1
Description of withdrawals and dropouts? 1