Abstract
Objectives: This prospective clinical study investigated the efficacy of adjunctive antibiotic therapy (doxycycline) and the patient's risk factors during initial healing of autogenous canine tooth transplantations. Methods: Sixty-seven patients (ranging from 11 to 37 years of age) treated with tooth transplantations were allocated to three parallel groups based on the tooth's intraoperative extraoral storage time (EST 0-3, 4-6, and 7-15 min) receiving different antibiotic regimens: (1) no antibiotics; (2) intraoperative intravenous (i.v.) single-shot antibiotics; and (3) intraoperative i.v. single-shot plus postoperative oral antibiotics for five days. Initial healing was rated according to pain intensity and clinical signs of pathology over a 21-day period. The influence of the following parameters was investigated using RStudio (linear regression and partial eta squared statistics): group, sex, age, nicotine abuse, tooth apex condition, preoperative ankylosis, displacement severity, jaw location, the number of simultaneous transplantations and other interventions, preoperative orthodontic extrusion, EST, and intraoperative complications. Results: No significant influence for sex (43 females, 24 males), tooth apex condition (19 open, 48 closed), displacement severity, jaw location (51 upper, 16 lower jaw), EST (mean 4.99 min), intraoperative complications (n = 13), or antibiotic regimen on pathology signs or pain intensity were found. Six patients reported medication side effects. Preoperative ankylosis (n = 15) and unsuccessful orthodontic extrusion (n = 16) increased postoperative pain (p = 0.020, ηP(2) = 0.08; p = 0.035, ηP(2) = 0.07). Multiple transplants (n = 14) and interventions in multiple regions (n = 27) affected pain and pathology (p = 0.002, ηP(2) = 0.14; p = 0.001, ηP(2) = 0.17). Increased age and nicotine abuse (n = 6) were associated with increased pathology signs (p = 0.024, ηP(2) = 0.08; p = 0.029, ηP(2) = 0.07). Conclusions: The results suggest that personalized rather than routine antibiotic therapy might be sufficient for initial healing in canine tooth transplantation. Deteriorating factors include preoperative ankylosis, orthodontic extrusion, an increased number of surgical sites, age, and nicotine abuse. Clinical Significance: Routine antibiotic prevention regimes may not be mandatory for initial healing in autogenous tooth transplantation, but a nuanced antibiotic strategy tailored to each patient's specific risk factors, which is in line with the principle of antibiotic stewardship, is needed.