Efficacy of Various Regimens of Inhibitor-Protected Penicillins on the Basis of Immunospecific Mixed Saliva Proteins in Patients after Dental Implantation: a Randomized Uncontrolled Trial

Background. The available comparative studies on issues of choosing antibiotic regimen in dental implantation are often observational and describe only visible postoperative signs. More objective assessment of postoperative period and comparison of approaches requires laboratory tests. One of the methods to be used at a dental appointment is to study examination of the biochemical properties of saliva.

Objective. To carry out comparative evaluation of single and prolonged regimens of amoxicillin/clavulanate administration after dental implantation indicated by nonspecific immunity in mixed saliva.

Methods. A randomized uncontrolled trial of 30 partially edentulous patients was conducted. The clinical phase of the study was performed at the Department of Propaedeutics of Surgical Dentistry, MSUMD; the laboratory phase — at the Pharmacology and Biological Chemistry Departments, MSUMD, in 2021–2022. The study included patients aged 18 to 75 years, anatomically suitable for dental implant placement. Patients with somatic diseases in the decompensation stage were excluded from the study. Patients were randomized into 2 groups. The group 1 was prescribed to take amoxicillin/clavulanate pills (875+125 mg) 30 minutes before surgery. The group 2 was to take amoxicillin/clavulanate (875+125 mg) 30 minutes before surgery and then 1 pill of Amoxicillin/ Clavulanate (500+125 mg) 2 times a day for 7 days after surgery. To evaluate the efficacy of the applied antibiotic therapy, unstimulated mixed saliva was collected from all patients on an empty stomach, 1 ml before surgery and on the third day after surgery. The amount of immunoglobulins of G, M, A classes (mg/l) and б-amylase activity (IU/l) were determined spectrophotometrically in the saliva samples. Statistical processing of laboratory data was performed using Welch's t-test by means of Statistica 10 Pro (StatSoft, USA). Intergroup and intragroup differences were considered significant at p ≤ 0.05.

Results. Based on the saliva proteins examined, the most pronounced difference between the patient groups was obtained for IgA. For other studied parameters of saliva, no significant difference between the groups was obtained on the third day after the surgery. However, despite the absence of a statistical difference, a tendency to a stronger increase in the amount of IgA, G, IgM, salivary amylase activity was noted for all indicators; moreover, a high correlation between immunoglobulins of class A, G, immunoglobulins of class G, M, and immunoglobulins of class A, M was revealed.

Conclusion. Among patients with the prolonged regimen, the groups did not differ significantly in such saliva parameters as immunoglobulins G and M and salivary б-amylase activity, however, a tendency to a stronger increase of the mentioned immunoglobulins in the saliva of group 1 patients was revealed. The most significant difference was recorded for immunoglobulin A in saliva, the amount of which was significantly lower in the group of prolonged antibiotic administration (p < 0.05).

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