Antibiotic Prophylaxis in the Prevention of Postoperative Infections in Mandibular Third Molar Extractions: Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis aims to evaluate the effectiveness of antibiotic prophylaxis in the prevention of surgical wound infection (SWI) following mandibular third molar extraction. Methods: A systematic search on electronic databases and a manual search on paper journals was carried out. Two independent reviewers selected the studies. The onset of SWI was used as the main outcome. The data from the studies were analyzed, both with the fixed and the random models, according to the type of antibiotic and the method of administration; a further stratification was adopted, if possible, based on surgical difficulty. The risk of bias and heterogeneity were evaluated. Results: 15 studies were included. Antibiotic prophylaxis, especially in pre-surgical administration and in case of osteotomy, is effective in the prevention of SWI in case of mandibular third molar extraction. Post-surgical administration of prophylaxis, although effective, does not seem to be fully supported by the literature. Pre- and post-surgical prophylaxis did not demonstrate superiority compared to pre-surgical administration alone. Conclusions: Antibiotic prophylaxis is effective in reducing SWI after third molar extraction; pre-surgical administration, minimizing antibiotics administration, allows one to reduce complications related to antibiotic and risk of onset of antibiotic resistance.