Prospective randomized double blind study of two antibiotics protocols for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients

Osteoradionecrosis (ORN) of jaws is a severe complication of head and neck cancer radiotherapy. Dental extractions in irradiated head and neck cancer patients increases ORN risk. A prospective, randomized, double blind study with two different ORN prevention antibiotics protocols were performed. Group 1 patients (G1) received 8th hourly oral amoxicillin 500mg for 8 days starting 1 day pre extraction, and group 2 patients (G2) received 8th hourly oral amoxicillin 500mg for 4 days starting 1 day pre extraction, followed by 4 days of a same appearance placebo drug. A total of 11 patients (10 male and one female) underwent extractions of teeth. Mean age of the patients was 56± 7 years, and 63,6% received more than 6.000cGy radiation dosages. Thirty-six surgery procedures were performed, and 51 teeth were extracted. After a mean follow-up period of 10± 7 months three ORN signals (maxilla 1/mandible 2) were reported, in 2 (18,1%) patients. Necrotic areas envolve theposterior region of jaws, presented previous radiographic lesion, had more than 13 minutes of surgery time, and envolved teeth with periodontal disease. No difference in ORN prevalence beetwen groups of patients, surgical procedures, or removed teeth were detected. The G2 protocol decreased ORN risk when teeth with periodontal problems were extracted.