Comparison of Effect of Amoxicillin Administered Locally Vs Systemically on Healing of Mandibular Third Molar Surgical Extraction Socket

Abstract

Background: Mandibular third molar impaction is a common clinical condition often necessitating surgical extraction, which is frequently accompanied by postoperative complications such as pain, edema, trismus, and localized infection. Although systemic antibiotics are routinely employed to mitigate these sequelae, concerns over adverse reactions and antimicrobial resistance have prompted interest in localized antibiotic delivery. This study aims to compare the clinical efficacy of local versus systemic amoxicillin administration in promoting postoperative healing and minimizing complications.

Materials and Methods: A prospective analytical cross-sectional study was conducted on 200 patients (18–50 years) undergoing mandibular third molar surgery. Patients were randomly assigned to two groups:

• Group A (Systemic): Oral amoxicillin–clavulanic acid 625 mg twice daily for 5 days.


• Group B (Local): 1 g of amoxicillin powder placed intra-alveolarly prior to surgical closure.

Postoperative evaluations on Days 3 and 7 included pain intensity (VAS), mouth opening (interincisal distance), swelling (clinical observation), wound healing (Landry Index), and adverse drug reactions. Data were analyzed using independent t-tests (p < 0.05 significant).

Results: The local group demonstrated superior trismus reduction (Day 3: 34.92 mm vs. 33.34 mm; p < 0.05) and early wound healing, with fewer adverse effects (0% vs. 4%). Pain scores were slightly lower in the local group on Day 3. While systemic antibiotics showed improved healing by Day 7, they were associated with gastrointestinal side effects.

Conclusion: Local administration of amoxicillin is a clinically effective alternative to systemic therapy, offering enhanced early healing and reduced systemic complications in mandibular third molar surgeries.