Aniello Capuano

F2-Isoprostanes in soft oral tissues and degree of oral disability after mandibular third molar surgery

OBJECTIVE The aim of this study was to test the value of F(2)-isoprostane (F(2)-IsoP) levels in the pericoronal gingiva as a potential predictor of oral disability after mandibular third molar (M3M) surgery. STUDY DESIGN Thirteen patients (5 male, 8 female) with partially impacted M3M were enrolled. Pericoronal soft tissues histology was obtained, gingival F(2)-IsoPs were measured by gas chromatography/negative-ion chemical ionization tandem mass spectrometry, and health-related quality of life (HRQOL) scores were assessed. RESULTS A variable degree of pericoronitis was evident before the M3M surgery, with a mean level of pericoronal F(2)-IsoPs of 634.8 ± 193.5 pg/mg of tissue. A significant positive correlation between pericoronal F(2)-IsoPs and HRQOL was observed in male (r(s) = 0.440; P = .0011), but not female (r(s) = -0.062; P = .5124) patients. CONCLUSIONS Levels of F(2)-IsoPs in the pericoronal soft tissues are correlated with the degree of oral disability after M3Ms surgery in male, but not female, patients.

Local Versus Systemic Antibiotics Effectiveness: A Comparative Study of Postoperative Oral Disability in Lower Third Molar Surgery

To the Editor: Impacted mandibular third molar (M3M) removal is a common intervention in oral and maxillofacial surgery. The occurrence of postoperative complications may seriously compromise the recovery and quality of life of patients: health-related quality of life (HRQOL) parameters suggested a worse healing time in patients with postoperative complications occurrence, which may be caused by preoperative inflammation or individual risk factors. There is a controversy in the literature about the use of antibiotics in third molar surgery: some authors suggest the prophylaxis use of antibiotics to reduce the occurrence of postoperative infection complications, whereas others support the idea that, in most cases, antibiotic prophylaxis is not necessary. Very few articles considered the use of local antibiotics in third molar surgery and their effectiveness in reducing postoperative complications and bacteria growth rate. We intended to report the results of our double-blind randomized controlled clinical trial on the effectiveness of local antibiotic administration, systemic antibiotic administration, and their association, compared with a control group, in preventing postoperative infection complications of M3M surgery. A total of 40 patients (16 males, 24 females; mean [SD] age, 31.5 [9.51]; range, 16Y50 y) with impactedM3Mswere enrolled and treated from January 1, 2012 to January 1, 2013 at the Tuscan School ofDental Medicine, University of Siena. We excluded patients with pathologies that could influence results regarding bacterial growth rate. Each patient was randomly assigned in groups in the study and the surgeon received antibiotics instructions, whereas the laboratory received no such information. Group 0 did not receive any antibiotic therapy (control group); group 1 was prescribed with a systemic antibiotic prophylaxis (amoxicillin and clavulanic acid); group 2 received local antibiotic administration (chloramphenicol sodium succinate), mixed with patient blood inside the surgical cavity, during the operative procedure; and group 3 received systemic prophylaxis and local antibiotic administration during the operative procedure. The patients of group 1 and group 3 were instructed to consume 2000 mg/h before surgery and keep 1000 mg as prophylaxis every 12 hours 5 days after the surgery. Local anesthesia and surgical protocol were standardized, except for antibiotic administration. We used a standardized technique to collect the specimen: reference points were the pocket between the secondmolar and the third molar and the former vertex of papilla. A paper cone was left in place for a time of 10 seconds, which was removed afterward and immediately placed in a sterile tube containing 1 mL of sterile saline solution (phosphate buffered saline) and delivered to the analytical laboratory for seeding in culture media (Fig. 1). We performed 3 collections: immediately before anesthesia (T0), 48 hours after intervention (T1), and 7 days after intervention (T2). The patients were visited also 14 days after the surgery with the delivery of the HRQOL diary. None of the examined participants exhibited severe complications. Milder complications at 2 days included swelling on the control group (n = 3), whereas no evidence of soft tissue infection, dry socket, or bone resorption was observed: groups 1, 2, and 3 presented no such complications at day 2. Milder complications at 7 days were swelling on the control group (n = 1), whereas no patients had soft tissue infection, dry socket, or bone resorption: groups 1, 2 and 3 presented no such complications at day 7. The HRQOL parameters revealed no statistically significant difference between the 4 groups in terms of time taken to reach the minimum value (time taken to reach complete remission of symptoms, P = 0.76) both in terms of change rate (the amount of recovery, P = 0.51) (Fig. 2). Regarding aerobic and anaerobic bacterial growth, by comparing the mean differences recorded at the time (T0, T1, T2) in the groups, there was no evidence of statistically significant difference. At T2, the anaerobes count is higher with respect to T0, with the exception of group 2. It should be noted that, in group 0 and group 2 at time T1, the mean value is increased, whereas, in group 1, this value is decreased and, in group 3, is controlled (Fig. 3). Regarding antibiotic administration, some authors suggested a prophylaxis administration (single presurgical dose of 2 tablets of amoxicillin/clavulanic acid, 1000/62.5 mg) in cases of third molar surgery performed without ostectomy, whereas considered an indication to postsurgical preemptive treatment (2 tablets of amoxicillin/ clavulanate daily, for 5 days) the M3M removal with ostectomy. One of the most recent studies provided no statistically significant results in the prophylactic routine use of systemic antibiotics. A recent metaanalysis observed that the most effective dosing strategy was with the first dose started 1 hour before surgery and continuing for 3 to 5 days after the surgery and that a preoperative single dose was nearly as effective as the multiday dosing strategy. The use of routine antibiotic prophylaxis in third molar surgery is a reliable way to reduce the appearance of alveolar osteitis, but the risks for potential antimicrobial FIGURE 1. The paper cone inside the site before the third molar surgery (T0). FIGURE 2. Health-related quality of life parameters significantly decrease with time, but no statistically difference is present among the different groups; however, a greater variance is present in group 0 (control group) compared with other groups, meaning a less controllable and predictable condition. CORRESPONDENCE

Pigmented dentigerous cyst.

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