The effect of postoperative antibiotics in reducing complications following primary surgical closure of oroantral communications secondary to tooth extraction: a retrospective multicenter study

Abstract Objectives Maxillary canine, premolar and molar extractions may result in oroantral communication (OAC). Surgical closure aims to prevent the development of a persistent oroantral fistula (OAF), thereby reducing the risk of maxillary sinusitis. There is no consensus regarding the benefit of the use of perioperative antibiotics. This study evaluated the effect of postoperative antibiotics on complications after primary OAC closure following tooth extraction. Materials and methods Eligible patients were identified by retrospectively reviewing the medical records of patients who underwent surgical closure of an OAC at Amsterdam UMC-VUmc and Amsterdam UMC-AMC from 2000 to 2025. Among these patients, the associations of various exposures, including postoperative antibiotic use, with overall complications, infectious complications, and persistent OAF were assessed. Group differences were assessed using the chi-square and independent t-tests, while univariate and multivariable associations were assessed using logistic regression ( p < 0.05). Number needed to be exposed to benefit (NNEB) and harm (NNEH) were calculated. Results A total of 725 potentially eligible participants were identified, of whom 505 were eligible; 308 (61.0%) were male, and 251 (49.7%) received postoperative antibiotics. Overall complications occurred in 11.7%, infectious complications in 8.2%, and persistent OAF in 3.6%. Postoperative antibiotic use was significantly associated with fewer overall and infectious complications and fewer persistent OAFs. (NNEB 6.9, 6.9, and 21.4, respectively). Autoimmune disease and use of intra-alveolar hemostatic agent were associated with increased overall complications. Soft tissue (partial) impaction was associated with increased risk for infectious complications. Use of intra-alveolar hemostatic agent and soft tissue (partial) impaction were associated with increased risk for persistent OAF. Conclusion Postoperative antibiotic use after primary OAC closure following tooth extraction was associated with reduced risk of overall and infectious complications and persistent OAFs. Prospective studies are needed to confirm these findings and guide antibiotic use. Clinical relevance Oral healthcare professionals should be aware of the potential benefit of postoperative antibiotics in preventing complications. Therefore antibiotic prophylaxis could be considered in patients with obvious risk factors or if an uneventful outcome is highly desirable.