The use of a tetracycline drain reduces alveolar osteitis: a randomized prospective trial of third molar surgery under local anesthetics and without the use of systemic antibiotics

Objectives. Our aim was to investigate the effect of an oxytetracycline-impregnated gauze drain on the incidence of alveolar osteitis (AO) and postoperative pain during the first week after mandibular third molar surgery. Study Design. Two hundred consecutive patients undergoing third molar surgery under local anesthesia were randomized into a drain group (n =100), with an oxytetracycline-impregnated drain placed in the extraction socket, and a control group (n = 100). An experienced surgeon performed the surgery. Systemic antibiotics were not used. Results. The incidence of AO was 23% in the control group and 5% in the drain group (P < .001). The risk of developing AO was approximately 6 times higher in the control group, and females had a 2.5 times higher risk compared with males. Patients in the control group had significantly more pain on the day of surgery and on days 4 to 7. The presence of AO was associated with continued use of analgesics (P < .001). No patients experienced postoperative infections or had complications requiring hospitalization. Conclusions. The present study showed that an oxytetracycline-impregnated drain significantly reduced the incidence of AO after third molar surgery. The described treatment strategy, without the use of systemic antibiotics, seemed efficient in lowering overall postoperative morbidity and downtime after third molar surgery.