Impact of Prophylactic Antibiotic Protocols in Cardiac Patients Undergoing Endodontic Surgery and Subsequent Prosthetic Treatment: A Comparative Study

Abstract

Background Invasive dental procedures, including endodontic surgery followed by prosthetic rehabilitation, can introduce a risk of infection, particularly in cardiac patients. Prophylactic antibiotics are commonly used to mitigate this risk, but their optimal protocol remains debated. This study aimed to compare the effectiveness of standard and extended antibiotic protocols in reducing postoperative infections, promoting prosthetic success, and preventing cardiac complications in cardiac patients undergoing endodontic surgery and subsequent prosthetic treatment.

Methods A total of 250 cardiac patients (125 in each group) undergoing endodontic surgery followed by prosthetic rehabilitation were randomly assigned to either a standard antibiotic protocol (Amoxicillin 2g preoperatively) or an extended antibiotic protocol (Amoxicillin 2g preoperatively followed by 500 mg every 8 hours for 48 hours post-surgery). The primary outcome was the rate of postoperative infections, and secondary outcomes included prosthetic success, antibiotic-related side effects, hospitalization, and cardiac complications. All patients were followed for 6 months.

Results The extended antibiotic protocol group showed a significantly lower postoperative infection rate (10.4%) compared to the standard protocol group (18%) (p = 0.031). Prosthetic success was higher in the extended protocol group (85.6%) compared to the standard protocol group (79.2%), but this difference was not statistically significant (p = 0.12). The extended protocol group had a higher incidence of antibiotic-related side effects (18.4%) compared to the standard group (12%) (p = 0.04). No cardiac complications were observed in either group, and hospitalization rates were similarly low across both groups.

Conclusion Extended prophylactic antibiotic therapy was associated with a lower infection rate in cardiac patients undergoing endodontic surgery and prosthetic rehabilitation, although it did not significantly impact prosthetic success or survival. The increased rate of side effects in the extended protocol group suggests the need for careful patient selection and antibiotic stewardship in this vulnerable population.