Investigating the effect of topical vancomycin on the rate of recovery and complications after mandibular third molar surgery

Third molar surgery is one of the most common surgeries performed to treat problems caused by impacted teeth. The use of vancomycin along with tobramycin polymethyl methacrylate topically has been successful in the treatment of chronic osteomyelitis and reducing the recurrence of osteomyelitis, and reducing pus drainage in maxillofacial. The present study investigates the effect of vancomycin on oral function and complications after mandibular impacted and partially-impacted third molar surgery. This study was a double-blind clinical trial (Surgeons, nurses, and patients were unaware of the type of medicine) conducted on patients who were candidates for mandibular impacted tooth surgery and were referred to the Kerman Faculty of Dentistry in 2022. In this regard, 40 patients with the same demographic characteristics and ASA conditions were randomly assigned to two groups of 20 people. One group did not receive any topical antibiotics (normal saline-impregnated Gelfoam) in the bone in the surgical site of the third molar of the mandible before closing the wound. The second group received 1 mg of vancomycin topically (Antibiotic-impregnated Gelfoam) in the existing bone defect. Then, the patients were compared in terms of pain severity and improvement of function and other complications one day after and the first week after surgery through a developed questionnaire. Based on the analysis and the results, the topical use of vancomycin antibiotic in the mandibular molar surgery improves the opening of the mouth one day after the procedure and the ability to return to a normal diet one day after surgery (mouth function) (two patients from the control group versus 5 patients from the control group). An improvement in the soft tissue was observed one week after surgery (6 patients had relatively complete recovery in the control group) and the need for debridement and drainage and systemic antibiotics (2 patients from the control group and none of the patients from the control group) during the first week. It was also effective in reducing pain within one day to one week after surgery. Accordingly, all patients have no pain or little pain for one day to one week after surgery in the control group. The effect of topical vancomycin on improving the ability to pronounce letters and improving mouth opening one week after surgery and the occurrence of dry socket, and debridement at the surgical site was not significant and effective in this project.