Antibiotics at replantation of avulsed permanent teeth? A systematic review

Jolyce Bourgeois; Joana Christina Carvalho; Mieke De Bruyne; Dominique Declerck; Anouk Eloot; Roos Leroy

doi:10.1016/j.jebdp.2022.101706

Antibiotics at replantation of avulsed permanent teeth? A systematic review

J Evid Based Dent Pract. 2022 Jun;22(2):101706. doi: 10.1016/j.jebdp.2022.101706. Epub 2022 Mar 2.

Authors

Jolyce Bourgeois¹, Joana Christina Carvalho², Mieke De Bruyne³, Dominique Declerck⁴, Anouk Eloot⁵, Roos Leroy⁶

Affiliations

¹ Belgian Health Care Knowledge Centre, Brussels, Belgium. Electronic address: jolyce.bourgeois@kce.fgov.be.
² Faculty of Medicine and Dentistry, School of Dentistry, UCLouvain, Brussels, Belgium.
³ Department of Oral Health Sciences, Ghent University Hospital, Ghent, Belgium.
⁴ Department of Pediatric Dentistry and Special Care, University Hospitals Leuven, Leuven, Belgium.
⁵ Private dental practice, Ghent, Belgium.
⁶ Belgian Health Care Knowledge Centre, Brussels, Belgium.

PMID: 35718435
DOI: 10.1016/j.jebdp.2022.101706

Abstract

Objectives: At present there is no clear consensus whether systemic antibiotics should be administered at replantation of an avulsed permanent tooth. This systematic review and meta-analysis assessed the evidence on effectiveness and harms of the administration of systemic antibiotics at replantation of avulsed permanent teeth.

Methods: In August 2020 a systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for systematic reviews, randomized controlled trials (RCT) and observational controlled studies in MEDLINE, PreMedline, Embase, and the Cochrane databases. The population of interest were medically fit patients with a replanted avulsed tooth. Main outcomes were tooth survival, periodontal healing, pulpal revascularization as well as (severe) adverse events. These outcomes were compared in patients who did and who did not receive systemic antibiotics. The GRADE methodology was used to assess the quality of evidence.

Results: The search yielded no RCTs, and none of the 7 included observational studies had the prime intent to investigate the effectiveness or harms of antibiotics. According to GRADE, the overall level of evidence was very low. The meta-analyses showed non-significant associations between the administration of systemic antibiotics on the one hand and tooth survival (1 study, RR = 3.70, 95% CI: 0.63-21.69), periodontal healing (meta-analysis of 6 studies RR: 1.07; 95% CI: 0.80-1.45), and pulpal revascularization (meta-analysis of 2 studies, RR: 0.36; 95% CI: 0.05-2.41) on the other hand.

Conclusion: Currently there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth. Hence, their routine use cannot be recommended in medically fit patients. Well-designed RCTs should be a priority on the research agenda.

Keywords: Anti-bacterial agents; therapeutic use, Tooth avulsion, Tooth replantation, Systematic reviews and evidence-Based Dentistry, Meta- analysis.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Anti-Bacterial Agents / therapeutic use
Dentition, Permanent
Humans
Tooth Avulsion* / surgery
Tooth Replantation / methods
Tooth*

Substances

Anti-Bacterial Agents