Page 142 - Demo

Chapter 7140Several earlier studies used some form of antibiotic prophylaxis for periapical surgical procedures [9, 11-12, 17]. In the present study, however, no antibiotics were prescribed. A previous randomized double-blind placebo-controlled trial comparing oral placebo and a preoperative dose of 600 mg clindamycin in 256 patients [23] reported an infection rate of 1.6% in the antibiotic prophylaxis group versus 3.2% in the placebo group. In the present study, 7 (5.3%) cases of postoperative infection occurred, which were treated with drainage and a 5-day course of amoxicillin. Patients with a postoperative infection had a significantly higher OHIP-14 score on day 5 and more pain on day 6. This study has some limitations. First, only asymptomatic cases were included; therefore, no conclusions can be drawn about the impact on OHRQoL in cases of acute periapical surgery. Second, we did not use an operating microscope in the periapical procedure. An operating microscope is used for optimal identification of root canals, fractures, and isthmuses [17], and some studies have reported that the use of microsurgical techniques is associated with less postoperative pain [1, 5-6]. Magnification was used in the present study, but the 5x magnification with the surgical loupes does not compare to visualization of 16 to 32 times as with the microscope. Although an earlier study did find that patients undergoing periapical surgery using a surgical microscope recovered sooner with respect to pain, no significant difference was found in postoperative swelling [1]. A disadvantage of performing periapical surgery with a microscope is that the procedure takes twice as long. Tsesis et al. [5] reported an average operating time of 20 minutes for periapical surgery without a microscope versus 40 minutes for periapical surgery using a microscope [6]. Moreover, in that study, the patients from the group operated on using a microscope experienced more difficulty in mouth opening, mastication, and the ability to speak during the first 2 days after surgery. In addition, no significant differences in pain were observed in those first 2 days. The differences in pain became clear starting with the fourth postoperative day, but the mean pain scores were ~2 on a 5-point scale. In contrast, in the present study, the mean pain scores were ≤2 on an 11-point NRS. Another limitation of the present study is that, although the OHIP-14 is a reliable and validated tool to measure OHRQoL, data acquired from the patients are self-reported. The usual disadvantage with questionnaires is that data