Complications After Lower Third Molar Surgery

Summary

Surgical removal of impacted mandibular wisdom teeth is a frequent intervention, usually accompanied by unpleasant sequelae (pain, swelling and trismus) in the postoperative period, sometimes even with possibly serious complications (dry socket/alveolar osteitis and postoperative infection at the surgical site - SSI). It is therefore advisable to use various medications and procedures to prevent or alleviate the occurrence of these sequelae and complications. Accordingly, there is a debate in the literature on the expedience of perioperative (prophylactic) use of antibiotics. It is interesting that numerous articles recommending perioperative (prophylactic) antibiotic use to patients undergoing the impacted mandibular third molar surgery may be found, as well as those providing arguments for the disagreement with such an approach, considering that its benefits do not outweigh the risks of adverse side effects, especially due to growing resistance of microorganisms towards antibiotics, which is a possible serious threat to global health. Concerning the perioperative (prophylactic) use of antibiotics for this indication, consensus has not yet been reached, and neither of the views has been verified by convincing scientific evidence. Having the aforementioned dilemma in mind, the main endpoint of the study was to determine the validity of perioperative (prophylactic) use of antibiotics as to alleviate customary sequelae and possible complications after surgical removal of impacted mandibular third molars and, at the same time, the effectiveness of newer antibiotics (moxifloxacin and cefixime) when used for this purpose. Moreover, microbiological investigations of susceptibility of the isolated microorganisms to antibiotics used in this research were performed, which could verify the clinically obtained results. With this in mind, two major contributions, based on scientifically verified results, could be expected from the research: (1) confirmation or refuting the validity of perioperative (prophylactic) antibiotic use to control sequelae or complications that could follow the impacted mandibular third molar surgery; and (2) confirmation of the efficacy of fluoroquinolones (moxifloxacin) and cephalosporins (cefixime) in controlling odontogenic infections.

Timeline

Start

2019-06-07

Primary completion

2023-12-31

Completion

2023-12-31

Publications

• Results Carter K, Worthington S. Predictors of Third Molar Impaction: A Systematic Review and Meta-analysis. J Dent Res. 2016 Mar;95(3):267-76. doi: 10.1177/0022034515615857. Epub 2015 Nov 11.
• Results Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007 Feb;19(1):117-28, vii. doi: 10.1016/j.coms.2006.11.013.
• Results Chuang SK, Perrott DH, Susarla SM, Dodson TB. Age as a risk factor for third molar surgery complications. J Oral Maxillofac Surg. 2007 Sep;65(9):1685-92. doi: 10.1016/j.joms.2007.04.019.
• Results Azenha MR, Kato RB, Bueno RB, Neto PJ, Ribeiro MC. Accidents and complications associated to third molar surgeries performed by dentistry students. Oral Maxillofac Surg. 2014 Dec;18(4):459-64. doi: 10.1007/s10006-013-0439-9. Epub 2013 Dec 27.
• Results Markovic AB, Todorovic L. Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):e4-8. doi: 10.1016/j.tripleo.2006.02.024. Epub 2006 Aug 10.
• Results Schalch TO, Palmieri M, Longo PL, Braz-Silva PH, Tortamano IP, Michel-Crosato E, Mayer MPA, Jorge WA, Bussadori SK, Pavani C, Negreiros RM, Horliana ACRT. Evaluation of photodynamic therapy in pericoronitis: Protocol of randomized, controlled, double-blind study. Medicine (Baltimore). 2019 Apr;98(17):e15312. doi: 10.1097/MD.0000000000015312.
• Results Kim JC, Choi SS, Wang SJ, Kim SG. Minor complications after mandibular third molar surgery: type, incidence, and possible prevention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Aug;102(2):e4-11. doi: 10.1016/j.tripleo.2005.10.050. Epub 2006 Jun 27.
• Results Monaco G, Staffolani C, Gatto MR, Checchi L. Antibiotic therapy in impacted third molar surgery. Eur J Oral Sci. 1999 Dec;107(6):437-41. doi: 10.1046/j.0909-8836.1999.eos107604.x.
• Results Monaco G, Tavernese L, Agostini R, Marchetti C. Evaluation of antibiotic prophylaxis in reducing postoperative infection after mandibular third molar extraction in young patients. J Oral Maxillofac Surg. 2009 Jul;67(7):1467-72. doi: 10.1016/j.joms.2008.12.066.
• Results Susarla SM, Dodson TB. Risk factors for third molar extraction difficulty. J Oral Maxillofac Surg. 2004 Nov;62(11):1363-71. doi: 10.1016/j.joms.2004.05.214.
• Results Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg. 2002 Feb;40(1):26-31. doi: 10.1054/bjom.2001.0684.
• Results Blum IR. Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. Int J Oral Maxillofac Surg. 2002 Jun;31(3):309-17. doi: 10.1054/ijom.2002.0263.
• Results Bowe DC, Rogers S, Stassen LF. The management of dry socket/alveolar osteitis. J Ir Dent Assoc. 2011 Dec-2012 Jan;57(6):305-10.
• Results Taberner-Vallverdu M, Nazir M, Sanchez-Garces MA, Gay-Escoda C. Efficacy of different methods used for dry socket management: A systematic review. Med Oral Patol Oral Cir Bucal. 2015 Sep 1;20(5):e633-9. doi: 10.4317/medoral.20589.
• Results Taberner-Vallverdu M, Sanchez-Garces MA, Gay-Escoda C. Efficacy of different methods used for dry socket prevention and risk factor analysis: A systematic review. Med Oral Patol Oral Cir Bucal. 2017 Nov 1;22(6):e750-e758. doi: 10.4317/medoral.21705.
• Results Kolokythas A, Olech E, Miloro M. Alveolar osteitis: a comprehensive review of concepts and controversies. Int J Dent. 2010;2010:249073. doi: 10.1155/2010/249073. Epub 2010 Jun 24.
• Results Daly B, Sharif MO, Newton T, Jones K, Worthington HV. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Rev. 2012 Dec 12;12:CD006968. doi: 10.1002/14651858.CD006968.pub2.
• Results Bortoluzzi MC, Capella DL, Barbieri T, Pagliarini M, Cavalieri T, Manfro R. A single dose of amoxicillin and dexamethasone for prevention of postoperative complications in third molar surgery: a randomized, double-blind, placebo controlled clinical trial. J Clin Med Res. 2013 Feb;5(1):26-33. doi: 10.4021/jocmr1160w. Epub 2013 Jan 11.
• Results Ren YF, Malmstrom HS. Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials. J Oral Maxillofac Surg. 2007 Oct;65(10):1909-21. doi: 10.1016/j.joms.2007.03.004.
• Results Benediktsdottir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Apr;97(4):438-46. doi: 10.1016/j.tripleo.2003.10.018.
• Results Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc. 2007 May;73(4):325.
• Results Lodi G, Figini L, Sardella A, Carrassi A, Del Fabbro M, Furness S. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev. 2012 Nov 14;11:CD003811. doi: 10.1002/14651858.CD003811.pub2.
• Results Friedman JW. The prophylactic extraction of third molars: a public health hazard. Am J Public Health. 2007 Sep;97(9):1554-9. doi: 10.2105/AJPH.2006.100271. Epub 2007 Jul 31.
• Results Salmeron-Escobar JI, del Amo-Fernandez de Velasco A. Antibiotic prophylaxis in Oral and Maxillofacial Surgery. Med Oral Patol Oral Cir Bucal. 2006 May 1;11(3):E292-6.
• Results Rodrigues WC, Okamoto R, Pellizzer EP, dos Carrijo AC, de Almeida RS, de Melo WM. Antibiotic prophylaxis for third molar extraction in healthy patients: Current scientific evidence. Quintessence Int. 2015 Feb;46(2):149-61. doi: 10.3290/j.qi.a32825.
• Results Moreno-Drada JA, Garcia-Perdomo HA. Effectiveness of Antimicrobial Prophylaxis in Preventing the Spread of Infection as a Result of Oral Procedures: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2016 Jul;74(7):1313-21. doi: 10.1016/j.joms.2016.03.006. Epub 2016 Mar 15.
• Results Moloney J, Stassen LF. Pericoronitis: treatment and a clinical dilemma. J Ir Dent Assoc. 2009 Aug-Sep;55(4):190-2.
• Results Wehr C, Cruz G, Young S, Fakhouri WD. An Insight into Acute Pericoronitis and the Need for an Evidence-Based Standard of Care. Dent J (Basel). 2019 Sep 2;7(3):88. doi: 10.3390/dj7030088.
• Results Davies SC, Fowler T, Watson J, Livermore DM, Walker D. Annual Report of the Chief Medical Officer: infection and the rise of antimicrobial resistance. Lancet. 2013 May 11;381(9878):1606-9. doi: 10.1016/S0140-6736(13)60604-2. Epub 2013 Mar 12. No abstract available.
• Results Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014 Dec;5(6):229-41. doi: 10.1177/2042098614554919.
• Results Marra F, George D, Chong M, Sutherland S, Patrick DM. Antibiotic prescribing by dentists has increased: Why? J Am Dent Assoc. 2016 May;147(5):320-7. doi: 10.1016/j.adaj.2015.12.014. Epub 2016 Feb 5.
• Results Roberts RM, Bartoces M, Thompson SE, Hicks LA. Antibiotic prescribing by general dentists in the United States, 2013. J Am Dent Assoc. 2017 Mar;148(3):172-178.e1. doi: 10.1016/j.adaj.2016.11.020. Epub 2017 Jan 23.
• Results Palmer NA, Pealing R, Ireland RS, Martin MV. A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J. 2000 May 27;188(10):554-8. doi: 10.1038/sj.bdj.4800538.
• Results Loffler C, Bohmer F, Hornung A, Lang H, Burmeister U, Podbielski A, Wollny A, Kundt G, Altiner A. Dental care resistance prevention and antibiotic prescribing modification-the cluster-randomised controlled DREAM trial. Implement Sci. 2014 Feb 22;9:27. doi: 10.1186/1748-5908-9-27.
• Results Loffler C, Bohmer F. The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review. PLoS One. 2017 Nov 14;12(11):e0188061. doi: 10.1371/journal.pone.0188061. eCollection 2017.
• Results Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT; American Heart Association. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc. 2008 Jan;139 Suppl:3S-24S. doi: 10.14219/jada.archive.2008.0346.
• Results Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet. 2015 Mar 28;385(9974):1219-28. doi: 10.1016/S0140-6736(14)62007-9. Epub 2014 Nov 18.
• Results Richey R, Wray D, Stokes T; Guideline Development Group. Prophylaxis against infective endocarditis: summary of NICE guidance. BMJ. 2008 Apr 5;336(7647):770-1. doi: 10.1136/bmj.39510.423148.AD. No abstract available.
• Results Diz Dios P, Tomas Carmona I, Limeres Posse J, Medina Henriquez J, Fernandez Feijoo J, Alvarez Fernandez M. Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions. Antimicrob Agents Chemother. 2006 Sep;50(9):2996-3002. doi: 10.1128/AAC.01550-05.
• Results Limeres J, Sanroman JF, Tomas I, Diz P. Patients' perception of recovery after third molar surgery following postoperative treatment with moxifloxacin versus amoxicillin and clavulanic acid: a randomized, double-blind, controlled study. J Oral Maxillofac Surg. 2009 Feb;67(2):286-91. doi: 10.1016/j.joms.2008.06.061.
• Results Cervino G, Cicciu M, Biondi A, Bocchieri S, Herford AS, Laino L, Fiorillo L. Antibiotic Prophylaxis on Third Molar Extraction: Systematic Review of Recent Data. Antibiotics (Basel). 2019 May 2;8(2):53. doi: 10.3390/antibiotics8020053.
• Results Sidana S, Mistry Y, Gandevivala A, Motwani N. Evaluation of the Need for Antibiotic Prophylaxis During Routine Intra-alveolar Dental Extractions in Healthy Patients: A Randomized Double-Blind Controlled Trial. J Evid Based Dent Pract. 2017 Sep;17(3):184-189. doi: 10.1016/j.jebdp.2017.04.007. Epub 2017 Apr 27.
• Results Prajapati A, Prajapati A, Sathaye S. Benefits of not Prescribing Prophylactic Antibiotics After Third Molar Surgery. J Maxillofac Oral Surg. 2016 Jun;15(2):217-20. doi: 10.1007/s12663-015-0814-1. Epub 2015 Jul 5.
• Results Kaczmarzyk T, Wichlinski J, Stypulkowska J, Zaleska M, Panas M, Woron J. Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery. Int J Oral Maxillofac Surg. 2007 May;36(5):417-22. doi: 10.1016/j.ijom.2006.12.003. Epub 2007 Apr 3.
• Results Marcussen KB, Laulund AS, Jorgensen HL, Pinholt EM. A Systematic Review on Effect of Single-Dose Preoperative Antibiotics at Surgical Osteotomy Extraction of Lower Third Molars. J Oral Maxillofac Surg. 2016 Apr;74(4):693-703. doi: 10.1016/j.joms.2015.11.017. Epub 2015 Nov 23.
• Results Lopez-Cedrun JL, Pijoan JI, Fernandez S, Santamaria J, Hernandez G. Efficacy of amoxicillin treatment in preventing postoperative complications in patients undergoing third molar surgery: a prospective, randomized, double-blind controlled study. J Oral Maxillofac Surg. 2011 Jun;69(6):e5-14. doi: 10.1016/j.joms.2011.01.019. Epub 2011 Apr 5.
• Results Halpern LR, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? J Oral Maxillofac Surg. 2007 Feb;65(2):177-85. doi: 10.1016/j.joms.2006.10.016.
• Results Arteagoitia I, Diez A, Barbier L, Santamaria G, Santamaria J. Efficacy of amoxicillin/clavulanic acid in preventing infectious and inflammatory complications following impacted mandibular third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jul;100(1):e11-8. doi: 10.1016/j.tripleo.2005.03.025.
• Results Menon RK, Gopinath D, Li KY, Leung YY, Botelho MG. Does the use of amoxicillin/amoxicillin-clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis. Int J Oral Maxillofac Surg. 2019 Feb;48(2):263-273. doi: 10.1016/j.ijom.2018.08.002. Epub 2018 Aug 23.
• Results Pham TDM, Ziora ZM, Blaskovich MAT. Quinolone antibiotics. Medchemcomm. 2019 Jun 28;10(10):1719-1739. doi: 10.1039/c9md00120d. eCollection 2019 Oct 1.
• Results Ardila CM, Guzman IC. Clinical Factors Influencing the Efficacy of Systemic Moxifloxacin in the Therapy of Patients With Generalized Aggressive Periodontitis: A Multilevel Analysis From a Clinical Trial. Glob J Health Sci. 2015 Jun 25;8(3):80-8. doi: 10.5539/gjhs.v8n3p80.
• Results Sobottka I, Wegscheider K, Balzer L, Boger RH, Hallier O, Giersdorf I, Streichert T, Haddad M, Platzer U, Cachovan G. Microbiological analysis of a prospective, randomized, double-blind trial comparing moxifloxacin and clindamycin in the treatment of odontogenic infiltrates and abscesses. Antimicrob Agents Chemother. 2012 May;56(5):2565-9. doi: 10.1128/AAC.06428-11. Epub 2012 Feb 21.
• Results Shrivastava R, Rai VK, Kumar A, Sinha S, Tripathi P, Gupta K, Sabharwal S. An in vitro Comparison of Endodontic Medicaments Propolis and Calcium Hydroxide alone and in Combination with Ciprofloxacin and Moxifloxacin against Enterococcus Faecalis. J Contemp Dent Pract. 2015 May 1;16(5):394-9. doi: 10.5005/jp-journals-10024-1696.
• Results Jones ME, Visser MR, Klootwijk M, Heisig P, Verhoef J, Schmitz FJ. Comparative activities of clinafloxacin, grepafloxacin, levofloxacin, moxifloxacin, ofloxacin, sparfloxacin, and trovafloxacin and nonquinolones linozelid, quinupristin-dalfopristin, gentamicin, and vancomycin against clinical isolates of ciprofloxacin-resistant and -susceptible Staphylococcus aureus strains. Antimicrob Agents Chemother. 1999 Feb;43(2):421-3. doi: 10.1128/AAC.43.2.421.
• Results Dalhoff A. Immunomodulatory activities of fluoroquinolones. Infection. 2005 Dec;33 Suppl 2:55-70. doi: 10.1007/s15010-005-8209-8.
• Results Dalhoff A, Shalit I. Immunomodulatory effects of quinolones. Lancet Infect Dis. 2003 Jun;3(6):359-71. doi: 10.1016/s1473-3099(03)00658-3.
• Results Lang MS, Gonzalez ML, Dodson TB. Do Antibiotics Decrease the Risk of Inflammatory Complications After Third Molar Removal in Community Practices? J Oral Maxillofac Surg. 2017 Feb;75(2):249-255. doi: 10.1016/j.joms.2016.09.044. Epub 2016 Oct 6.
• Results Ardila CM, Florez-Florez J, Castaneda-Parra LD, Guzman IC, Bedoya-Garcia JA. Moxifloxacin versus amoxicillin plus metronidazole as adjunctive therapy for generalized aggressive periodontitis: a pilot randomized controlled clinical trial. Quintessence Int. 2020;51(8):612-621. doi: 10.3290/j.qi.a44715.
• Results Oomens MA, Forouzanfar T. Antibiotic prophylaxis in third molar surgery: a review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Dec;114(6):e5-12. doi: 10.1016/j.oooo.2011.10.023. Epub 2012 May 30.
• Results Poeschl PW, Eckel D, Poeschl E. Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity? J Oral Maxillofac Surg. 2004 Jan;62(1):3-8; discussion 9. doi: 10.1016/j.joms.2003.05.004.
• Results Warnke PH, Becker ST, Springer IN, Haerle F, Ullmann U, Russo PA, Wiltfang J, Fickenscher H, Schubert S. Penicillin compared with other advanced broad spectrum antibiotics regarding antibacterial activity against oral pathogens isolated from odontogenic abscesses. J Craniomaxillofac Surg. 2008 Dec;36(8):462-7. doi: 10.1016/j.jcms.2008.07.001. Epub 2008 Aug 29.
• Results Tally FP, Desjardins RE, McCarthy EF, Cartwright K. Safety profile of cefixime. Pediatr Infect Dis J. 1987 Oct;6(10):976-80. doi: 10.1097/00006454-198710000-00037.
• Results Martens E, Demain AL. The antibiotic resistance crisis, with a focus on the United States. J Antibiot (Tokyo). 2017 May;70(5):520-526. doi: 10.1038/ja.2017.30. Epub 2017 Mar 1.
• Results Lacasa JM, Jimenez JA, Ferras V, Bossom M, Sola-Morales O, Garcia-Rey C, Aguilar L, Garau J. Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg). Int J Oral Maxillofac Surg. 2007 Apr;36(4):321-7. doi: 10.1016/j.ijom.2006.11.007. Epub 2007 Jan 16.
• Results Blumenthal KG, Lu N, Zhang Y, Walensky RP, Choi HK. Recorded Penicillin Allergy and Risk of Mortality: a Population-Based Matched Cohort Study. J Gen Intern Med. 2019 Sep;34(9):1685-1687. doi: 10.1007/s11606-019-04991-y. No abstract available.
• Results Redgrave LS, Sutton SB, Webber MA, Piddock LJ. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role in evolutionary success. Trends Microbiol. 2014 Aug;22(8):438-45. doi: 10.1016/j.tim.2014.04.007. Epub 2014 May 16.
• Results Chaudhry SB, Veve MP, Wagner JL. Cephalosporins: A Focus on Side Chains and beta-Lactam Cross-Reactivity. Pharmacy (Basel). 2019 Jul 29;7(3):103. doi: 10.3390/pharmacy7030103.
• Results Al-Nawas B, Walter C, Morbach T, Seitner N, Siegel E, Maeurer M, Krummenauer F. Clinical and microbiological efficacy of moxifloxacin versus amoxicillin/clavulanic acid in severe odontogenic abscesses: a pilot study. Eur J Clin Microbiol Infect Dis. 2009 Jan;28(1):75-82. doi: 10.1007/s10096-008-0587-2. Epub 2008 Jul 29.
• Results Nymoen Aasbrenn M, Skeie I, Berild D. Compliance to antibiotic guidelines leads to more appropriate use of antibiotics in skin and soft tissue infections in injecting drug users. Infect Dis (Lond). 2019 Aug;51(8):570-577. doi: 10.1080/23744235.2019.1617435. Epub 2019 May 30.
• Results Poeschl PW, Spusta L, Russmueller G, Seemann R, Hirschl A, Poeschl E, Klug C, Ewers R. Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Aug;110(2):151-6. doi: 10.1016/j.tripleo.2009.12.039. Epub 2010 Mar 25.
• Results Arteagoitia MI, Barbier L, Santamaria J, Santamaria G, Ramos E. Efficacy of amoxicillin and amoxicillin/clavulanic acid in the prevention of infection and dry socket after third molar extraction. A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2016 Jul 1;21(4):e494-504. doi: 10.4317/medoral.21139.
• Results Gomez-Arambula H, Hidalgo-Hurtado A, Rodriguez-Flores R, Gonzalez-Amaro AM, Garrocho-Rangel A, Pozos-Guillen A. Moxifloxacin versus Clindamycin/Ceftriaxone in the management of odontogenic maxillofacial infectious processes: A preliminary, intrahospital, controlled clinical trial. J Clin Exp Dent. 2015 Dec 1;7(5):e634-9. doi: 10.4317/jced.52627. eCollection 2015 Dec.
• Results Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011 Mar;55(2):111-5. doi: 10.4103/0019-5049.79879.

Drugs

Indications