Antibiotics in Mucogingival Surgery for Recession Treatment: A Narrative Review

Abstract

Gingival recession is a common problem, particularly affecting oral health and esthetics, and its treatment involves surgical root coverage procedures. The aim of this narrative review is to evaluate the role of systemic antibiotic therapy in mucogingival surgery for recession treatment. The available literature does not support routine antibiotic use in systemically healthy patients undergoing recession coverage surgery. Indications for prophylactic antibiotics are restricted to individuals at high risk of infective endocarditis and immunocompromised patients with elevated susceptibility to surgical site infections. Although mucogingival surgeries are performed in a non-sterile environment, the risk of infection remains low when proper aseptic techniques and good preoperative tissue preparation are applied. The review emphasizes the importance of making clinical decisions that consider the patient's health status and are aligned with current recommendations. It also emphasizes the necessity for prospective studies to evaluate antibiotics' effect on recession coverage procedures outcome. To bridge the gap between contemporary evidence and clinical practice and to foster responsible use of antibiotics in periodontal plastic surgery, the authors of this review integrate current evidence and clinical guidelines into a practical tool designed to assist clinicians in making reasoned, evidence-based decisions.

Keywords: anti-bacterial agents; antibiotic prophylaxis; bacterial; connective tissue grafts; drug resistance; gingival recession; mucogingival surgery; surgical wound infection; wound healing.

Figure 1

Recommendations for antibiotic prophylaxis in patients with cardiovascular diseases undergoing oro-dental procedures at increased risk for infective endocarditis [16]. Adapted with permission from Ref. [16]. Copyright 2023, Oxford University Press.

Figure 2

Prophylactic antibiotic regime for IE high-risk dental procedures and doses for adults [16,17]. a—Other first- or second-generation oral cephalosporin in equivalent dosing; b—Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticarial with penicillin or ampicillin. Adapted with permission from Ref. [16]. Copyright 2023, Oxford University Press.

Figure 3

(A–C), Performance of periodontal plastic surgery (coronally advanced flap plus connective tissue graft) in mandibular incisor affected by gingival recession. (D), Flap necrosis one week after surgery.

Figure 4

Patients at higher risk of developing surgical site infection.

Figure 5

(A), Plaque-induced gingival inflammation as a contraindication for performing a surgical recession coverage procedure; (B), the clinical situation, following improvement in the patient’s plaque control and professional mechanical plaque-removal procedures; (C), recession coverage with laterally closed tunnel and SCTG; (D), 2 weeks post-surgery; (E), 6 months post-surgery.