Clinical Evaluation of Antibiotic Prophylaxis before Endodontic Treatment of Necrotic Teeth

Objective: Endodontic treatment of necrotic teeth might be complicated by post-treatment flare-up pain and swelling. The aim of this study was to evaluate if antibiotic prophylaxis before endodontic treatment of necrotic teeth can prevent these complications. Methods: 25 patients with 1 tooth with pulpal necrosis and periapical radiolucency each were selected. All teeth were asymptomatic. A Rx was taken for each tooth. Using a scanner, the Rx were digitalized and the dimensions of the periapical radiolucencies were calculated using an image analysis software (Image Pro Plus). Patients were randomly divided into 2 groups. The first group (n=13) was given an antibiotic prophylaxis with 2 gr. amoxicilline 1 hrs before treatment, while the control group (n=12) did not receive any medication. The endodontic therapy was performed in both groups shaping canals with the crown-down technique using stainless steel hand files, 5% sodium hypoclorite irrigations and 2 intermediate medications with calcium hydroxide. Obturation was performed using the System B method. 3 Rx were taken during treatment (to determine working length, cone fitting and obturation). At the end of each appointment a questionnaire was given to each patient. The patients had to indicate if pain (absent, light, mild, severe) or swelling were present at 4, 8, 12, 24, 48 hrs from treatment. Data were statistically analysed with the Mann-Whitney and Wilcoxon tests. Results: Results showed only one case of flare up pain and swelling in a patient of group 1. The statistical analysis showed that there were not significant differences between the two groups. No correlation was found between radiolucencies dimensions and post-treatment pain. Conclusion: An accurate endodontic treatment is sufficient to guarantee an adeguate control of post-treatment pain, with no need of antibiotic prophylaxis.