The efficacy of antibiotic prophylaxis for impacted and semi-impacted third molar surgery: A prospective randomized double-blind clinical trial




Antibiotic prophylaxis; Oral surgery; Third molar.


Impacted and semi-impacted third molar surgery is a frequent dental procedure. Due to potentially major tissue manipulation during surgery, antibiotic prophylaxis may be indicated to prevent infection of the surgical wound. This study evaluated the surgical conditions of patients following extraction of impacted and semi-impacted third molars with or without prior antibiotic prophylaxis. Signs of infection and inflammation, postoperative pain level and efficacy of the prescribed drugs were recorded. This was a prospective, randomized, double blind clinical trial with split-mouth design. A total of 23 healthy (ASA I) volunteers with indication for bilateral mandibular third molar extraction were recruited, totaling 46 surgical procedures. One hour prior to the procedure, volunteers received 1g of amoxicillin or placebo and a drug for pain prevention and control. The surgical acts were performed by last-year dental students. Postoperative pain was assessed using a visual analogue scale and an 11-point box scale at selected postoperative intervals of 4 h, 12 h, and 24 h. After seven postoperative days, study volunteers were examined for clinical signs of infection and/or inflammation, such as pus, intra and extraoral swelling, trismus, heat, flushing and temperature change. There were only two cases of postoperative complications, one of intraoral edema (placebo group) and one of trismus (antibiotic prophylaxis group). There were no statistically significant differences for any of the indicative signs of infection. The pain scales revealed no differences between pain levels in both groups at all times evaluated, regardless of the pain scale used (P > 0.05). To conclude, the low infection rate observed in our study does not reflect any need for antibiotic prescription in systemically healthy patients. The adverse effects of antibiotics in addition to selection for resistant bacteria outweigh the benefits of antibiotic prophylaxis in healthy (ASA I) patients.


Bezerra, T. P., Studart-Soares, E. C., Scaparo, H. C., Pita-Neto, I. C., Batista, S. H. B., & Fonteles, C. S. R. (2011). Prophylaxis versus placebo treatment for infective and inflammatory complications of surgical third molar removal: A split-mouth, double-blind, controlled, clinical trial with amoxicillin (500 mg). J Oral Maxillofac Surg. 69(11). e333–9.

Blatt, S., & Al-Nawas, B. (2019). A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery. Infection. Springer Berlin Heidelberg. 47. 519–555.

Bortoluzzi, M. C., Capella, D. L., Barbieri, T., Pagliarini, M., Cavalieri, T., & Manfro, R. (2013). A Single Dose of Amoxicillin and Dexamethasone for Prevention of Postoperative Complications in Third Molar Surgery: A Randomized, Double-Blind, Placebo Controlled Clinical Trial. J Clin Med Res. 5(1). 26–33.

Brigantini, L. C., Marques, G. J., & Gimenes, M. (2016). Antibióticos em odontologia. Uningá. 49(S3). 121–7.

Collins, S. L., Moore, A. R., & McQuay, H. J. (1997). The visual analogue pain intensity scale: what is moderate pain im millimeters. Pain. 72:95–7.

Conrado, B. Á., Souza, S. A. de, Mallet, A. C. T., Souza, E. B. de, Neves, A. dos S., & Saron, M. L. G. (2018). Disbiose Intestinal em idosos e aplicabilidade dos probióticos e prebióticos. Cad UniFOA. 36. 71–8.

Cubas-Jaeger, J. L., & Asmat-Abanto, A. S. (2016). Amoxicilina para prevenir la infección postexodoncia de terceros molares incluidos: ensayo clínico aleatorizado. Rev Esp Cir Oral y Maxilofac. 38(4). 188–92.

Dos Santos, D. R., & Quesada, G. A. T. (2008). Prevalência de terceiros molares e suas respectivas posições segundo as classificações de Winter e de Pell e Gregory. Rev Cir e Traumatol Buco-Maxilo-Facial. 5458(1). 83–92.

Gill, A. S., Morrissey, H., & Rahman, A. (2018). A systematic review and meta-analysis evaluating antibiotic prophylaxis in dental implants and extraction procedures. Med. 54(6). 1–27.

Jensen, M. P., Karoly, P., & Braver, S. (1986). The measurement of clinical pain intensity: a comparison of six methods. Pain. 27(1). 117–26.

Kato, R. B., Bueno, R. de B. L., Neto, P. J. de O., Ribeiro, M. C., & Azenha, M. R. (2010). Acidentes e Complicações Associadas à Cirurgia dos Terceiros Molares Realizada por Alunos de Odontologia. Rev Cir e Traumatol Buco-maxilo-facial. 10(4). 45–54.

Milani, B. A., Bauer, H. C., Sampaio-Filho H., Horliana,. A. C. R. T., Perez, F. E. G., Tortamano, I. P., et al. (2015). Antibiotic therapy in fully impacted lower third molar surgery: randomized three-arm, double-blind, controlled trial. Oral Maxillofac Surg. 19(4). 341–6.

Monaco, G., Tavernese, L., Agostini, R., & Marchetti, C. (2009). Evaluation of Antibiotic Prophylaxis in Reducing Postoperative Infection After Mandibular Third Molar Extraction in Young Patients. J Oral Maxillofac Surg. 67(7). 1467–72.

Normando, D. (2015). Third molars: to extract or not to extract? Dental Press J Orthod. 20(4). 17–8.

Roy, I., Baliga, S. D., Louis, A., & Rao, S. (2015). Importance of Clinical and Radiological Parameters in Assessment of Surgical Difficulty in Removal of Impacted Mandibular 3rd Molars: A New Index. J Maxillofac Oral Surg. 14(3). 745–9.

Santosh, P. (2015). Impacted mandibular third molars: Review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res. 5(4). 229.

Sarica, I., Derindag, G., Kurtuldu, E., Naralan, M., & Caglayan, F. (2019). A retrospective study: Do all impacted teeth cause pathology? Niger J Clin Pract. 22(4). 527–33.

Seguro, D., & Oliveira, R. V. (2014). Complicações Pós-Cirurgicas Na Remoção De Terceiros Molares Inclusos. Rev UNINGÁ. 20(1). 30–4.

Siddiqi, A., Morkel, J. A., & Zafar, S. (2010). Antibiotic prophylaxis in third molar surgery: A randomized double-blind placebo-controlled clinical trial using split-mouth technique. Int J Oral Maxillofac Surg. 39(2). 107–14.

Trento, C. L., Zini, M. M., Moreschi, E., Zamponi, M., Gottardo, D. V., Cariani, J. P. (2009). Localização e classificação de terceiros molares: análise radiográfica. Interbio. 3(2). 18–26.

Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., et al. (2007). Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 116(15). 1736–54.




How to Cite

GANGÁ, A. P. S. .; TARANTINO, H. A. P. .; ARPINI, N. B. .; FERREIRA, T. P. .; MELLO, P. S. de .; COSER, R. C. . The efficacy of antibiotic prophylaxis for impacted and semi-impacted third molar surgery: A prospective randomized double-blind clinical trial . Research, Society and Development, [S. l.], v. 10, n. 9, p. e58610918398, 2021. DOI: 10.33448/rsd-v10i9.18398. Disponível em: Acesso em: 26 sep. 2021.



Health Sciences